construction accident case study in malaysia

Hazard and safety evaluation in construction sites in Malaysia: A case study

• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Reprints and Permissions
• Cite Icon Cite
• Search Site

M. Fathullah , N. R. Nik Yusoff , Vertic Eridani Budi Darmawan , C. P. Yong , C. G. Eng , S. P. Er , T. M. Ying , W. Q. Hui; Hazard and safety evaluation in construction sites in Malaysia: A case study. AIP Conf. Proc. 3 May 2021; 2339 (1): 020183. https://doi.org/10.1063/5.0045234

Download citation file:

• Ris (Zotero)
• Reference Manager

This paper reports on case studies of safety incidents in Malaysia. In line with the efforts to reduce accidents at construction sites in Malaysia, the objective of this study is to analyze on workplace hazard, risk and safety and proposes a recommended actions on the case analyzed. A total of five case studies were conducted, in which the cases are scope to be on construction sites in Malaysia. Five hazards are identified from the case studies, which are equipment or machine falls from height, defective sockets or electrical equipment, high unfenced and unguarded working area, sharp objects or cutting blades, and noise pollution. The effects of these hazard are studied and Fishbone diagram is used to identified the root causes that lead to the effect. HIRARC is then used for further study of the hazard identified into risk analysis and risk control. Through risk analysis in HIRARC, the risk scores of each hazard are calculated, and the risk scores are analysed into a Pareto Chart. The purpose of Pareto Chart is to study on the priority of hazards to be focus on. Control measures are suggested based on descending order of priority: defective sockets or electrical equipment, high unfenced and unguarded working area, equipment or machine falls from height, noise pollution, and lastly sharp objects or cutting blades.

Citing articles via

Publish with us - request a quote.

Sign up for alerts

• Online ISSN 1551-7616
• Print ISSN 0094-243X
• For Researchers
• For Librarians
• For Advertisers
• Our Publishing Partners  
• Physics Today
• Conference Proceedings
• Special Topics

pubs.aip.org

• Privacy Policy
• Terms of Use

Connect with AIP Publishing

This feature is available to subscribers only.

Sign In or Create an Account

We apologize for the inconvenience...

To ensure we keep this website safe, please can you confirm you are a human by ticking the box below.

If you are unable to complete the above request please contact us using the below link, providing a screenshot of your experience.

https://ioppublishing.org/contacts/

Causes of Construction Accidents and the Provisions of Safety Regulations in Construction Industry in Malaysia

• Conference paper
• First Online: 01 January 2021
• Cite this conference paper

• Ku Adenan Ku Ismail 13 &
• Idris Othman 14  

Part of the book series: Lecture Notes in Civil Engineering ((LNCE,volume 132))

Included in the following conference series:

• Proceedings of the International Conference on Civil, Offshore and Environmental Engineering

1721 Accesses

2 Citations

In order to improve safety performance, Malaysian government has gazetted an occupational safety and health policies to provide guidelines to be followed in dealing with occupational safety and health activities at site. Meanwhile, Factories and Machinery Act provide regulation with respect to the health, health and welfare of person, machinery and for matters connected therewith for the control of factories. This paper aims to identify cause of accidents and the provisions of safety regulations in construction projects in Malaysia. Methodology is by analysing the DOSH report. Statistic from DOSH shown that from 2015 to 2019, about 116% increase in accident cases. The main causes of accidents are work at high, unsafe work practice or conditions and failure of structure. Under Section 15 of OSHA 1994, contractors and employers can be charged under this section if fail to provide a healthy and safe working environment for their employees.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Workers Safety at Indian Construction Sites—A Survey

Site Accidents in the South African Construction Industry: Cleaning the Augean Stables

Study of Fatal Accidents Among Building Constructions Labours in Bangladesh

DOSH: Statistic on occupational accidents (2020). http://www.dosh.gov.my/index.php/statistic-v/occupational-accident-statistics-v

Othman, I., Majid, R., Mohamad, H., Shafiq, N., Napiah, M.: Variety of accident causes in construction industry. In: MATEC Web of Conferences, vol. 203, p. 02006 (2018)

Google Scholar  

Othman, I., Ibrahim, M.F.H., Shafiq, N., Mohamad, H., Kamil, M.S.: HSE management system for hot work operation at high elevation in shipbuilding project. In: MATEC Web of Conferences, vol. 203, p. 02005 (2018)

Rahim, A., Hamid, A., Zaimi, M., Majid, A., Singh, B.: Causes of accidents at construction sites. Malaysian J. Civ. Eng. 20 , 242–259 (2008)

Ahmad, A.: Best practices in safety management for conventional civil construction industry in Malaysia. Master Thesis of Science Construction Management, Malaysia. Universiti Teknologi Malaysia (2008)

Bakri, A., Zin, R.M., Misnan, M.S., Mohammed, A.H.: occupational safety and health management system: towards development of safety and health culture. In: Proceeding of 6th Asia-Pacific Structural Engineering and Construction Conference (APSEC 2006), Kuala Lumpur, Malaysia, pp. 19–28 (2006)

Othman, I., Mohamad, H., Napiah, M., Hashim, Z., Cai, Z.: The framework for effective safety control and implementation at construction project. Int. J. Eng. Technol. Manage. Res 5 , 28–42 (2018). http://www.ijetmr.com

Othman, I., Mohamad, H., Sapari, N., Shafiq, N., Ibrahim, F., Kamil, S.: HSE management system at high elevation in shipbuilding project. Int. J. Eng. Technol. Manage. Res 5 , 117–127 (2018). http://www.ijetmr.com

Othman, I., Ghani, S.N., Mohamad, H., Alalou, W., Shafiq, N.: Early warning signs of project failure. In: MATEC Web of Conferences, vol. 203, p. 02008 (2018)

Keng, T.C., Razak, N.A.: Case studies on the safety management at construction site. Journal of Sustainability Science and Management, vol. 9, no. 2 December 2014. Department of Quantity Surveying, Kulliyah of Architecture & Environmental Design, International Islamic University Malaysia, Jalan Gombak, 53100 Kuala Lumpur, Malaysia (2014)

Othman, I., Shafiq, N., Nuruddin, M.F.: Effective safety management in construction project. IOP Conf. Ser. Mater. Sci. Eng. 291 (1), 012018 (2017)

Article   Google Scholar  

Othman, I., Klufallah, M.M.A., Napiah, M., Nuruddin, M.F.: Effectiveness of preventive safety management in construction. In: Engineering Challenges for Sustainable Future, vol. 155 (2016)

Othman, I., Napiah, M., Nuruddin, M.F., Klufallah, M.M.A.: Effectiveness of safety management in oil and gas project. Appl. Mech. Mater. 815 , 429–433 (2015)

Zhou, Q., Fang, D., Mohamed, S.: Safety climate improvement: case study in a chinese construction company. J. Constr. Eng. Manage. 137 , 86–95 (2011)

Othman, I.: Safety management practices at construction site. Proceeding 3rd International Conference on Environment (2010)

DOSH: Occupational Safety and Health Act 1994. DOSH Malaysia, Kuala Lumpur (1994)

Othman, I., Harahap, M.I.P., Mohamad, H., Shafiq, N., Napiah, M.: Development of BIM-based safety management model focusing on safety rule violations. In: MATEC Web of Conferences, vol. 203, p. 02007 (2018)

Section 15 of OSHA 1994 Act 514 Occupational Safety and Health Act 1994 Incorporating all amendments up to 1, p. 16, January 2006

DOSH 1983 Factories and Machinery (safety, health and welfare) regulations 1970 (revised 1983) (Kuala Lumpur: DOSH Malaysia) p. 25

DOSH 2007 Guidelines for the Prevention of Falls at Workplaces (Kuala Lumpur: DOSH Malaysia) p. 68

Section 19 of OSHA 1994 Act 514 Occupational Safety and Health Act 1994 Incorporating all amendments up to 1, p. 18, January 2006

Section 20 of OSHA 1994 Act 514 Occupational Safety and Health Act 1994 Incorporating all amendments up to 1, p. 18, January 2006

Section 23 of OSHA 1994 Act 514 Occupational Safety and Health Act 1994 Incorporating all amendments up to 1, p. 21, January 2006

Section 24 of OSHA 1994 Act 514 Occupational Safety and Health Act 1994 Incorporating all amendments up to 1, p. 21, January 2006

Download references

Author information

Authors and affiliations.

Maju Perak Holdings Berhad, No. 1-a, Jalan Meru Casuarina, 30020, Ipoh, Perak, Malaysia

Ku Adenan Ku Ismail

University Teknologi PETRONAS, 32610, Seri Iskandar, Perak, Malaysia

Idris Othman

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Idris Othman .

Editor information

Editors and affiliations.

Civil and Environmental Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Perak, Malaysia

Bashar S. Mohammed

Civil and Environmental Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia

Nasir Shafiq

Shamsul Rahman M. Kutty

Hisham Mohamad

Abdul-Lateef Balogun

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this paper

Cite this paper.

Ismail, K.A.K., Othman, I. (2021). Causes of Construction Accidents and the Provisions of Safety Regulations in Construction Industry in Malaysia. In: Mohammed, B.S., Shafiq, N., Rahman M. Kutty, S., Mohamad, H., Balogun, AL. (eds) ICCOEE2020. ICCOEE 2021. Lecture Notes in Civil Engineering, vol 132. Springer, Singapore. https://doi.org/10.1007/978-981-33-6311-3_69

Download citation

DOI : https://doi.org/10.1007/978-981-33-6311-3_69

Published : 01 January 2021

Publisher Name : Springer, Singapore

Print ISBN : 978-981-33-6310-6

Online ISBN : 978-981-33-6311-3

eBook Packages : Engineering Engineering (R0)

Share this paper

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

The Malaysian Lawyer

Latest updates on malaysian law, top 5 construction cases in malaysia for 2020.

Our guest author, Kevin Wong , writes on the top 5 construction cases in Malaysia for 2020. The areas covered include when does time run for the calculation of liquidated damages, the Controller of Housing, and cases on the Construction Industry Payment and Adjudication Act 2012 (CIPAA).

#1: Sri Damansara – Court of Appeal Answers When Does LAD Start to Run?

( Sri Damansara Sdn Bhd v Voon Kuan Chien & Anor [2020] 4 MLJ 265; [2020] 5 CLJ 619, COA with the grounds of judgment dated 5 March 2020 )

Judges: Hasnah Mohammed Hashim JCA, Kamaludin Md Said JCA, and Lee Swee Seng JCA (delivering the judgment of the court)

Why is this case important?

This case concerns homebuyers as to whether the calculation of liquidated and ascertained damages (LAD) on late delivery of vacant possession should be calculated from the date of payment of booking fee or the date of the sale and purchase agreement (SPA).

In this case, the Tribunal for Homebuyer Claims (Tribunal) originally decided in favour of the homebuyer. LAD was calculated from the date of payment of the booking fee to the date of delivery of vacant possession. The developer had argued that the calculation should have been from the date of the SPA.

Dissatisfied, the developer applied for judicial review against the Tribunal’s decision. The High Court also agreed with the homebuyer’s basis of calculation from the date of booking fee. The developer then appealed to the Court of Appeal.

In this case, the Court of Appeal departed from two previous Court of Appeal decisions finding calculation was to run from the date of the SPA:

GJH Avenue Sdn Bhd v Tribunal Tuntutan Pembeli Rumah, Kementerian Kesejahteraan Bandar, Perumahan Dan Kerajaan Tempatan & Ors [2019] MLJU 861 and PJD Regency Sdn Bhd v Tribunal Tuntutan Pembeli Rumah & Ors [2019] MLJU 2067.

Instead, the Court of Appeal affirmed the High Court’s decision that the calculation was to run from the booking fee. The Court of Appeal held that the Housing Development (Control and Licensing) Act 1966 (HDA) is a social piece of legislation designed to protect the homebuyers who are in a more vulnerable position because of the inequality of bargaining power.

Further, the Court of Appeal did not appear to apply a consistent approach. In this case, the Court stated that the collection of any booking fee is strictly prohibited under the HDA. On the other hand, the Court allowed the date of the booking fee to be used for the computation of LAD. A decision from the Federal Court would be welcomed to put to rest the conflicting Court of Appeal decisions and the issues concerning the booking fee and the HDA.

#2: Alvin Leong Wai Kuan – High Court Decides that There is Retrospective Effect of Ang Ming Lee  Decision

( Alvin Leong Wai Kuan & Ors v Menteri Kesejahteraan Bandar, Perumahan Dan Kerajaan Tempatan & Ors And Other Applications [2020] 10 MLJ 689; [2020] 6 CLJ 55, HC with the grounds of judgment dated 20 March 2020 )

Judge : Wong Kian Kheong J

Why is the case important?

This case addressed to issue whether the Federal Court’s recent decision of Ang Ming Lee & Ors v. Menteri Kesejahteraan Bandar, Perumahan Dan Kerajaan Tempatan & Anor And Other Appeals [2020] 1 MLJ 281; [2020] 1 CLJ 162 ( Ang Ming Lee ) has retrospective effect.

In Ang Ming Lee , the Federal Court essentially decided that the Controller of Housing has no powers to grant any extension to a developer to complete the development.

In this case, the Controller of Housing granted the developer an extension of delivery of vacant possession to 54 months. The developer appealed to the Minister of Housing and Local Government (Minister). The Minister extended the period to 59 months (Decision).

Aggrieved by the Decision of the Minister, the purchasers filed judicial review applications to quash the Decision. Riding on Ang Ming Lee, the High Court allowed the purchasers’ judicial review applications.

The High Court made four points:

First , Regulation 12 of Housing Development (Control and Licensing) Regulations 1989 provides that the Minister’s decision “ shall be final and shall not be questioned in any court ”. This part of the regulation is invalid as it ousted the Court’s judicial power.

Second , even though these applications were filed before Ang Ming Lee , the judgment in Ang Ming Lee has retrospective effect and applies to the current applications. It is also in the interest of homebuyers for the judgment in Ang Ming Lee to be given retrospective effect.

Third , the Controller and the Minister cannot extend the time beyond the 36 months prescribed in Schedule H of the Housing Development (Control and Licensing) Act 1966.

Fourth , the homebuyers are entitled to claim for liquidated and ascertained damages based on the 36 months.

This case cements the rights of homebuyers to claim liquidated and ascertained damages for delivery beyond the statutory limit 24 or 36 months and potentially open the floodgates for more homebuyers to challenge to the Controller and Minister’s decisions to extend the time beyond the statutory limit.

#3: Maju Holdings Sdn Bhd – High Court Decides Whether an Adjudication Decision Can be a Disputed Debt

( Maju Holdings Sdn Bhd v Spring Energy Sdn Bhd [2020] MLJU 1196, HC with the grounds of judgment dated 21 August 2020 )

Judge : Ong Chee Kwan JC

Prior to this decision, the High Court in ASM Development (KL) Sdn Bhd v Econpile (M) Sdn Bhd [2020] MLJU 282 ( ASM ) held that an enforced adjudication decision can still be treated as a disputed debt. This is because an adjudication decision is only of temporary finality. The present case departed from ASM.

In this case, the Defendant commenced adjudication proceedings against the Plaintiff and was successful. Thereafter, the Defendant successfully applied to enforce the adjudication decision. The Defendant then issued a statutory notice of demand. The Plaintiff applied to restrain the Defendant from presenting a winding up petition.

First, the High Court allowed the Plaintiff’s application on the basis that the court was satisfied that the cross-claims by the Defendant is more than the statutory demand amount. Second, the High Court also held that an enforced adjudication decision is an undisputed debt. This decision is directly in conflict with ASM .

ASM is currently on appeal. A decision from the appellate courts is warranted to solidify the nature of an enforced adjudication decision registered pursuant to section 28 of CIPAA.

#4: Multazam Development Sdn Bhd – High Court Decision on the Nature of an Adjudication Order

( Multazam Development Sdn Bhd v Felda Global Ventures Plantations (M) Sdn Bhd [2020] 11 MLJU 606, HC with the grounds of judgment dated 15 May 2020 )

Judge : Lim Chong Fong J

This is the first decision to determine the nature of an order (not decision) made by an adjudicator in relation to costs awarded from the withdrawal of adjudication proceedings under CIPAA.

In this case, Multazam (Plaintiff) withdrew its adjudication proceedings against Felda (Defendant) when the proceedings were in progress. The parties could not agree on the quantum of the cost of withdrawal. The adjudicator determined the amount to be borne by the Plaintiff. Dissatisfied, the Plaintiff made an application to the High Court to, among others, set aside the order made by the adjudicator.

After hearing the application, the High Court remitted the issue on legal cost back to the adjudicator for reconsideration. Upon reconsideration, the adjudicator reaffirmed his previous order. The Plaintiff made another application to the High Court to set aside the revised order leading to the present case.

First , the High Court held that there is no provision in the CIPAA which permits an appeal or even the setting aside of a cost order made by an adjudicator.

Second , the High Court highlighted that the Plaintiff’s complaint was in substance an appeal against the adjudication order.

Third , the High Court could not entertain the Plaintiff’s complaint as the High Court has not been statutorily clothed with the jurisdiction power to do so.

This decision seals the finality of an order made by an adjudicator. Also, it serves as a timely reminder for a party who intends to initiate adjudication proceedings to bear in mind that an adjudication order (akin to a direction from the court) is not appealable and cannot be set aside.

#5: Spring Energy Sdn Bhd – Sessions Court Decides on Alternative Speedy Resolution for Contractors

( Spring Energy Sdn Bhd v Maju Holdings Sdn Bhd [2020] MLJU 902 , SESSC with the grounds of judgment dated 1 July 2020 )

Judges : Zulqarnain Bin Hassan

Since coming into effect in April 2014, CIPAA has been a salvation for the construction industry to resolve payment-related disputes. However, the adjudication lifeline came to a halt from March 2020 to November 2020. During that period, there was no director of the Asian International Arbitration Centre (AIAC) to appoint adjudicators. This decision is useful in setting out an alternative to CIPAA as it has the effect of resolving payment disputes in the construction industry speedily.

In this case, Spring Energy (Plaintiff) commenced an action against Maju Holdings (Defendant) for sums due and owing pursuant to Payment Certificates No. 22 and No. 23. The Plaintiff successfully obtained a summary judgment. The Sessions Court held that, among others, the Plaintiff had proved a clear-cut case against the Defendant as the payment certificates issued contained the elements of clarity, finality and incontrovertibility. The issuance of payment certificates amounted to an admission by the Defendant and that the Plaintiff was entitled to the payments.

The adjudication process is back on track with the appointment the director of the AIAC on 1 December 2020. However, this decision opens up more options for contractors (where an arbitration clause does not govern their contracts) to resolve their payment disputes swiftly.

Kevin Wong is the partner in the Construction and Energy practice of Khong Partnership . He has experience in the entire range of dispute resolution processes including adjudication, litigation and arbitration.

Read the rest of the series:

• Top 5 Company Law Cases in Malaysia for 2020
• Top 5 Tax Cases in Malaysia for 2020
• Top 5 Restructuring and Insolvency Cases in Malaysia for 2020
• Top 5 Arbitration Cases in Malaysia for 2020

Share this:

Leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Notify me of follow-up comments by email.

Notify me of new posts by email.

Puspakom loses concession for vehicle inspection, but becomes first licensed firm amid interest from nearly 50 others 

DBKL: No, Jln Yap Ah Loy isn’t being renamed as Jln Palestin; Jln Raja Laut 1 already called that since 2020

In open letter to PM, tech giants push back against Malaysia’s ‘unworkable’ social media licence and call for a pause to consider effect on economy

No Dr Sarah Jamal works here, UM says after viral online post of ‘huge empty cave’ beneath KL credits her as varsity’s geologist

What is ‘Kutty’ in a name? Here’s what Dr M told the court

Married couple in Kepong charged with child neglect after three-year-old daughter tested positive for drugs

When it rains, it pours: Experts warn heatwave in Malaysia could give way to bigger floods

Flash floods ravage Thailand: 22 dead, including Russian couple, thousands more displaced

Ebit Lew sexting trial: Married woman says too many pictures, messages so she deleted them, unsure if it was to ‘save own skin’

Ampang teen raped after letting man met on Litmatch app into home, mum discovered CCTV disabled

With ‘once-in-100-years’ flood again possible, Taman Sri Muda folk say mitigation work still not ready

Teluk Cempedak runner, 20, dies of heatstroke after morning event; second case in Pahang

Taliban says keen for good relations with Malaysia, wants help for Afghanistan in higher education system

Don’t forget to pack some patience: Singapore authorities say school holiday traffic is expected to surge at Woodlands and Tuas checkpoints

Missing 15-year-old Tawau girl found, police confirm

Crane gantry crash: suke contractors fined rm300,000 over failure to ensure safety at cheras construction site.

KUALA LUMPUR, Oct 11 — Two contractors involved in the Sungai Besi-Ulu Klang Elevated Expressway (SUKE) project have been fined a total of RM300,000 for failing to ensure site safety that resulted in a fatal accident on March 22.

Construction Industry Development Board (CIDB) Malaysia in a statement said the main contractor for Package CA3 (CH4200-CH7800 alignment) Muhibah Perniagaan dan Pembinaan Sdn Bhd was fined RM100,000, while subcontractor China Communications Construction Company (M) Sdn Bhd was slapped with an RM200,000 penalty.

Disciplinary proceedings held by the board on September 20 also found both the contractors to have violated Section 34B (1))(b) of the CIDB Act which states that it is the contractor’s duty to ensure the safety of buildings and construction work either during or after construction.

If the contractor fails to ensure safety, CIDB may impose a penalty not exceeding RM500,000 on the contractor.

On March 22, three foreign workers were crushed to death while a motorist was seriously injured when the crane gantry toppled over at the highway construction site near Puncak Banyan, Persiaran Alam Damai in Cheras.

“To ensure public safety, and determine work measures for the SUKE project, CIDB also recommends that the contractor have a safety audit done by a third party on the safety of the project, working methods and operation and management of the construction site,” the statement said.

In November last year, the main contractor and subcontractor of package CA2 of the SUKE project were fined RM80,000 and RM100,000 respectively, following an incident in which a concrete slab fell from the elevated highway and crushed a passing vehicle on September 19, 2020.

 In the meantime, CIDB chief executive Datuk Ahmad Asri Abdul Hamid said CIDB took every construction site accident seriously and reminded industry players to always remain committed to improve safety aspects as well as occupational safety and health measures at work sites. — Bernama

You May Also Like

Related articles.

King presents instruments of appointment to seven envoys

Teen charged with murder of 10-year-old Orang Asli girl Nuraina Humaira

Muhyiddin pleads not guilty to sedition charge over ‘3R’ remarks during Nenggiri campaign

An investigation into occupational health and safety of scaffolding practices on construction sites in Malaysia

Frontiers in Engineering and Built Environment

ISSN : 2634-2499

Article publication date: 12 October 2021

Issue publication date: 1 February 2022

Statistics show that the construction sector has the second-highest number of accident cases in Malaysia. A total of 100, 000 construction workers suffer from work-related bad health each year. Scaffolding accidents are the second cause of accidents on construction sites. Therefore, this present research provided answers to the following questions: (1) what are the causes of scaffolding accidents and (2) what are the possible measures to reduce scaffolding accidents?

Design/methodology/approach

The research developed a questionnaire instrument that included 24 causes of scaffolding accidents and 21 remedial actions. The research was based on a cross-sectional survey questionnaire administered to 129 members of construction organizations.

Data revealed that scaffolding-related cases caused a total of 70% of the deaths/injuries on sites. Furthermore, scaffolding accidents were mainly caused by a lack of guard rails on scaffoldings, poor inspections, improper assembly, a poor safety culture, poor attitudes towards safety, poor footing of scaffoldings and unsecured planking. To reduce scaffolding accidents, there must be a lifeline on scaffolding, proper guardrails and proper assembling of scaffoldings, and preventing access to incomplete or defective scaffoldings. The 24 causes are structured into six factors through factor analysis and the 21 remedial actions into six factors.

Originality/value

This research serves as the first attempt to conduct broad research on the causes and remedial actions concerning scaffolding accidents on construction sites in Malaysia. Theoretically, the research has provided fresh insights into the impact of scaffolding accidents.

• Physical injuries

Olanrewaju, A. , Khor, J.S. and Preece, C.N. (2022), "An investigation into occupational health and safety of scaffolding practices on construction sites in Malaysia", Frontiers in Engineering and Built Environment , Vol. 2 No. 1, pp. 1-21. https://doi.org/10.1108/FEBE-08-2021-0037

Emerald Publishing Limited

Copyright © 2021, AbdulLateef Olanrewaju, Jack Son Khor and Christopher Nigel Preece

Published in Frontiers in Engineering and Built Environment . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

The construction sector plays a significant role by demanding a large-scale workforce in the labour market, and it contributes about 10% to the gross domestic product in many countries ( Schilling, 2013 ; Research and Markets, 2020 ). However, the safety levels within the construction sector are low, and accidents on construction sites are increasing and have remained a global phenomenon ( Olanrewaju and Abdul-Aziz, 2015 ; Zhou et al. , 2015 ; Chong and Low, 2014 ; HSE, 2019 ). Between 2014 and 2017, close to 30% of all fatal accidents at work in the EU-28 took place within the construction sector ( Eurostat, 2019 ). Similarly, the construction sector has the highest fatalities in Singapore at 29% ( OSHD, 2017 ). The cost of workplace injuries in the UK construction sector was £1,204 m in 2018 ( HSE, 2019b ). The annual compensation for industrial accidents in Malaysia is RM 1.034 bn ( Bakar, 2018 ). Therefore, a reduction in accidents on sites will lead to a reduction in workers' compensation, insurance claims, a decrease in litigation charges, reduced time loss and increased productivity.

Most construction site accidents are caused by scaffolding erection, dismantling, malfunctioning and collapsing ( Zhou et al. , 2015 ; Winge and Albrechtsen, 2018 ; Eurostat, 2019 ). Like in most countries, the rates of accidents on Malaysian construction sites due to scaffolding are increasing ( Olanrewaju et al. , 2021 ). For instance, in 2012, the number of accidents due to scaffolding totalled 30 and that number increased to 227 in 2016 ( Social Security Organization Annual Report, 2012–2016 ). Ayob et al. (2018) found that 46.28% of the accidents are related to scaffolding. Furthermore, government-sponsored research shows that work at height is the biggest single cause of accidents in the Malaysian construction sector ( CIDB, 2018 ). The alarming rate of scaffolding accidents led to a special committee (the Position Paper Committee) in 2013 by the Institution of Engineers Malaysia ( The Institution of Engineers, Malaysia, 2015 ). Yet, there have been more studies and reports on accidents relating to scaffolding on construction sites in Malaysia ( Abas et al. , 2020 ; Ayob et al. , 2018 ; Williams et al. , 2017 ; Ulang et al. , 2014 ; Keng and Abdul Razak, 2014 ; Lee et al. , 2018 ; CIDB, 2018 ). As much as the findings and recommendations for the studies are helpful, the studies tend not to go into the level of detail necessary to provide systemic explanations of the causes and remedial actions required for scaffolding accidents on construction sites. This research has emerged to commence a detailed investigation on scaffolding accidents on construction sites in Malaysia. This research examined the causes of scaffolding accidents and possible remedies to reduce scaffolding accidents to achieve this aim.

2. Background and literature review

The costs of accidents on construction projects are enormous and comprise both latent and explicit costs. The explicit costs of accidents on construction sites are medical bills, compensation, claims and fines. The latent costs include losses of productivity, costs of retraining new staff, delays in project completion and loss of morals, social discrimination and grief of the families of the victims. Despite various measures taken to improve construction site safety records, existing research revealed that accidents and injuries continued to plague the industry ( Zhou et al. , 2015 ; Pieko et al. , 2018 ; Dogan et al. , 2021 ; Wang et al. , 2020 ; Rubio-Romero et al. , 2019 ; Czarnocka et al. , 2020 ).The census data from the USA showed that a total of 774 workers died from injuries suffered on construction sites in 2010 ( BLS, 2012 ). Similarly, 38 deaths and 64,000 injuries were recorded in the UK construction sector in 2017 ( Lucas, 2018 ). According to Sawacha et al. (1999) , for every pound paid by insurance companies, the contractor paid between £5 and £50. Anecdotal data show that total losses due to construction activities-related accidents were 10% of the total turnover. Analysing the latest data on work-related ill-health in the UK, Lucas (2018) found a loss of 1.9 million working days within the construction sector, equating to around 8,000 construction workers being absent from work for an entire year. In Malaysia, the accident rates in the construction sector are the second largest, representing 23.70% of the total accidents in all the major economic industries and number one in terms of the cause of fatalities ( Social Security Organization Annual Report, 2018 ). Every year, at least 95 deaths are documented on construction sites.

While the rate of accidents on construction sites is large and increasing unabated, the primary cause of accidents is related to the operations of scaffolding ( Olanrewaju et al. , 2021 ; Hola et al. , 2018 ; Rubio-Romero et al. , 2019 ; Czarnocka et al. , 2020 ; Dogan et al. , 2021 ). Scaffoldings are provided where work cannot be safely done from the ground or a part of a building or other permanent structures ( ILO, 1992 ). It is estimated that 65% of construction workers use scaffolding on construction sites ( OSHA, 2019 ). Occupational safety and health administration’s (OSHA) data found that 13.03% of the 1,215 falls in the USA were due to scaffolding ( OSHA, 2019 ). Falling from scaffolding, ladders and fixed platforms are the most hazardous scaffolding in Greece ( Aneziris et al. , 2012 ) scaffolding. Falls from scaffoldings are the major types of falls and causes of death in the Turkish construction sector ( Gürcanli and Müngen, 2013 ). Recent research shows that the number of accidents involving scaffolding contractors has increased from 89 in 2017 to 113 in 2018 in the UK ( Construction Manager, 2019 ). This represents 27%. Based on an analysis of 1,630,452 construction accidents in Spain, López et al. (2008) found that accidents due to scaffoldings and ladders topped the list in terms of fatalities and severity. Similarly, scaffolding accidents have led to many fatalities and injuries in Belgium ( Global Construction Review, 2021 ). Consistent with findings in most economies, scaffolding-related accidents, injuries and fatalities are the dominant causes of injuries and deaths on Malaysian construction sites ( Olanrewaju et al. , 2021 ). Scaffolding accidents have increased by about 800% over five years ( Social Security Organization Annual Report, 2018 ). Furthermore, while scaffolding accidents only accounted for 2.68% of the total causes in 2012, they increased to 23.35% in 2016. Therefore, protecting workers from scaffolding-related accidents may prevent the loss of many lives, claims, disputes, project delays and cost overruns. In Malaysia, it will avoid over 5,000 injuries and over 100 deaths every year. It will also reduce claims, litigation, productivity loss and loss of profit margin. These gaps justify the need for appropriate research.

Therefore, there is a systemic need to answer the question of “What are the causes of scaffolding accidents on Malaysian construction sites?” and find remedies to prevent or eliminate scaffolding accidents on sites. To provide answers to these questions, a cross-sectional survey questionnaire was conducted. Extant academic literature suggests these can be achieved by examining the causes and measures to reduce accidents on construction sites ( Olanrewaju et al. , 2021 ). There have been numerous research accidents on construction sites worldwide ( Hamdan and Awang, 2015 ; Szóstak et al. , 2021 ; Zhou et al. , 2015 ; Awwad et al. , 2016 ; López et al. , 2008 ). However, empirical studies on scaffolding accidents on sites, especially in Malaysia, are scanty despite the continuous increase and impact of scaffolding accidents. The previous studies were primarily concerned with the ranking of the causes. Research on remedies from the perspective of the site operative is nascent.

However, because the causes interact, it is essential to examine the relationship among the causes of the accidents and between the remedies. To close this knowledge gap, there is a systemic need to answer the questions of “What are the causes of scaffolding accidents on Malaysian construction sites” and what? And what are the remedies to prevent or eliminate scaffolding accidents on sites? This research identified, prioritized and categorized the causes and remedies. Categorizing the causes and remedies will help streamline and enhance decision-making on the performance of construction operations ( Olanrewaju and Idrus, 2020 ). Analyses of interactions between causes and remedies pose a clustering problem due to the lack of labelling in the data. A clustering problem is a situation where the machine is trained on unlabelled data without prior guidance. Some algorithms for uncategorized learning include K-mean, C-mean and factor analysis. Factor analysis is used here because it is consistent with the aim of this research. Whilst there is no definitive list of causes and remedies to scaffolding accidents, Tables 1 and 2 contain a list of causes and potential measures to reduce the accidents. The lists are not prescriptive and comprehensive but indicative of the nature of the causes and remedies. The causes and remedies are not specific to scaffolding per se .

3. Research methodology

The primary data were based on convenience sampling. The method is appropriate where sufficient information on population size and sample frame is not available. While the findings may not be generalizable, the conclusion can be representative of the population with many respondents. This is consistent with the central limit theorem (CLT). Based on the CLT principle, the distribution of sample means approximates a normal distribution as the sample size increases ( Olanrewaju and Idrus, 2020 ). For the CLT principle to be valid, a sample size of 30 or more is statistically required. The questionnaires were administered to the respondents between 6/08/2018 and 19/08/2018. The surveys were administered to site operatives (site operative denotes all those that work on construction) through online and face-to-face methods. Respondents were asked based on evidence to tick the degree to which they disagreed or agreed that each of the causal factors/remedies would lead to or reduce scaffolding accidents. The degrees of disagreement or agreement were measured on a four-continuum scale, where 4 denoted “strongly agree” and 1 denoted “strongly disagree”. 2 and 3 were located in between. The causes and remedies were developed from an extensive literature review ( Tables 1 and 2 ) and a discussion with those involved in the use/manufacture/supply of scaffoldings. It should be noted that the causes and remedies listed in Tables 1 and 2 are not the same as the causes and remedies submitted to the respondents for evaluations. This is related to ontological as well as epistemological considerations. During the pilot survey, it became clear that some of the causes and remedies included on the survey form were either irrelevant to the local environment or would require different interpretations. As a result, while some of the causes and remedies were eliminated, others were adjusted. In some cases, new ones were included in response to the respondents' suggestions during the pilot survey. Altogether, 24 causal factors and 21 remedies were included in the survey form after two pilot surveys. The questionnaire went through three pilot surveys comprising construction operatives on three different sites visited separately within a week. The extent of the cause or remedy is determined by an Average Relative Index (ARI) ( Eqn 1 ). (1) ARI = ∑ i = 0 4 a i x i 4 ∑ i = 0 4 x i × 100

The constant a i was the index of a group, which expressed the weight given to the group; x i was the frequency of response; i  = 1, 2, 3 and 4 and described as below: x 1 , x 2 , x 3 , x 4 where the frequencies of the responses corresponding to a 1 = 1 , a 2 = 2 , a 3 = 3 , a 4 = 4 . For interpretation purposes, an ARI score of 1.00–25.00 denotes not common at all; 26.00–50.00 denotes not common and 51.00–75 and 76.00–100.00 denote very common. There is a pooled difference of 1.0% between each of the scales. The causal factor with the highest ARI score was considered to be the major cause of scaffolding accidents. The prioritization of the remedies followed similar methods of analysis. Other computed statistical tests are the one-way t -test, Cronbach alpha's reliability tests, convergent validity tests, factor analysis, mode test and standard deviation. The t -test was conducted to test the hypothesis of whether each of the causes could lead to scaffolding accidents or if each remedy would aid the reduction of scaffolding accidents or not. A factor analysis was conducted to identify the association among causes and remedies of scaffolding accidents to facilitate systemic decision-making rather than analytical decision-making on ranking/prioritization. Analytical decision-making is fragmented and biased in a multi-criteria decision-making situation where conflicting criteria require holistic evaluation. Structuring complex criteria explicitly lead to more informed and better decisions. Factor analysis is an unsupervised machine learning algorithm used in grouping constructs that are not obvious or labelled before the computations. Some classifications were previously conducted (Chi and Wu,1997; Chi et al. , 2005 ; Hinze et al. , 1998). However, the classifications were not based on surveys; instead, they were based on epidemiological studies. The SAS Enterprise Guide 7.1 was used to analyse the data.

4. Analysing the results of the survey

The face-to-face survey pooled 100 forms, but only 37 completed responses were received during the survey period. The online survey forms were administered to more than 2000 respondents, including architects, engineers, construction managers and others that work on construction sites. However, by the cutoff date, 92 online responses were received after several reminders.

4.1 Analysing the respondents' profiles

The results show that more than 70% of the respondents worked on construction sites. The 30% may be accounted for by those that received the survey forms from their friends/colleagues. More than 76% of the respondents worked with contracting companies, and 20% worked with housing developers ( Figure 1 ). The results showed that more than 90% of the respondents had a minimum of a bachelor's degree, and more than 70% had more than three years of working experience. It is not surprising that most of the respondents held bachelor's degrees, and a total of 40% of the survey respondents have been injured on construction sites ( Table 3 ), and around 95% of respondents' work was related to using scaffolding. In the USA, 65% of construction workers' work involves scaffolding ( Collins et al. , 2014 ). Furthermore, the results show that one-fourth of the respondents have been injured while working with scaffolding on sites. This result is supported by the government report that shows that scaffolding contributed 23.35% of the site accidents ( Social Security Organization Annual Report, 2018 ).

4.2 Analysing the hierarchy of the causal factors

The combined average Cronbach coefficient alpha for the 24 causes of scaffolding accidents was 0.760. The combined validity results for the scaffolding accidents were 0.669. The Kaiser's measure of sampling adequacy was significant χ 2 (276) = 644.898, p  < 0.001), N  = 0.668). A one-way t -test was conducted to examine the measurements of the sample concerning the population. The null hypothesis was that each of the causes would not lead to scaffolding accidents (H0: U = U0), and the research hypothesis was that each of the causes would lead to scaffolding accidents (Hr: U ≥ U0). U0 was the population mean. The t -test results show that all the causes (Hr: U ≥ U0) were significant. The standard errors are approximated to zero. A small standard error is an indication that a sample mean is a more accurate replication of an actual population mean. However, for design flaws (0.46), lack of experience (0.379), poor management of work at heights (0.911) and not following CIDB (Construction Sector Development Board Malaysia) standards (0.141), the H0 were accepted. This happens because there are some disagreements among the respondents on the impact of these causes on scaffolding accidents. In general, the interpretations of these statistics are that the causes of accidents and their measurements were appropriate to achieve the designed objective. In total, 20% of the respondents disagreed that the causal factors could lead to scaffolding accidents, but the remaining 80% measured that the causes would lead to accidents. The cumulative average ARI for all the causes was 77.74, and the combined standard deviation was 18.43. Measured on a scale of 1–4 and considering the profiles of the respondents and the number of cases, these statistics are significant. Considering the relationship between mean and standard deviation, the results imply that 70% of the respondents estimated that the causes would lead to accidents. In particular, applying the distributive scale under the research methodology section, none of the causal factors fell under 50 ARI ( Table 4 ). Specifically, 15 causal factors cluster under “strongly agree” and 9 under “agree”.

4.3 Results of the factor analysis on the causes of scaffolding accidents

The overall root mean square off-diagonal residuals of 0.0584 indicates a lack of multicollinearity. The commonalities except for shortages of material (0.402) were all above 0.5. The data were subjected to a principal component analysis. The Kaiser's MSA (a measure of sampling adequacy) was approximately 0.833, which was very high. The results found that the 24 causal factors for scaffolding accidents may be structured or organized into six meaningful components for effective decisions. The six factors explained 62% of the total variance ( Table 5 ), and this was also evident in Figure 2 , as the function appeared to level off with the 6th factor.

4.3.1 Analysing the hierarchy of remedial measures

The combined average Cronbach coefficient alpha results for the 21 remedies of scaffolding accidents were 0.760. The combined validity results for all the scaffolding remedies were 0.669. The Kaiser's measure of sampling adequacy was significant χ 2 (276) = 644.898, p  < 0.001), N  = 0.668). The remedies (Hr: U ≥ U0) were generally statistically significant. However, the H 0 was accepted for holding weekly toolbox meetings (0.144), maintaining the required distance between scaffolding and power (0.812), promoting open communication (0.566), introducing a licencing system for scaffolding work similar to that used by the government for asbestos work (0.482) and imposing sanctions on companies that violate safety regulations (0.415). The results revealed that 13% of the respondents disagreed that the remedies could reduce accidents. A total of 87% of the respondents measured that the remedies could help to reduce accidents. The cumulative average ARI for all the remedies was 81.98, and the standard deviation was 16.83. A total of 70% agreed or strongly agreed (i.e. ARI = 65.14–98.81) that the remedies would reduce scaffolding accidents. None of the remedies fell under 50 ARI ( Table 6 ). More than 86% of remedies cluster under the “strongly agreed” category and the remaining 14% cluster under the “agreed” category.

4.4 Results of the factor analysis on the remedies to scaffolding accidents

The overall root mean square off-diagonal residuals was 0.0637, and the root mean square off-diagonal partials: Overall was 0.1801. This indicates a lack of multicollinearity. The Kaiser's MSA for the remedies was approximately 0.80. This result implies that the respondents were drawn from similar backgrounds and that the remedies suit their designed objective. The results found that the remedies may be structured or organized into six meaningful factors ( Table 7 and Figure 3 ).

5. Discussion of findings

In the following sections, the findings are discussed. Due to space constraints, only the first five causes and remedies will be discussed. Similarly, only the summary of the factor analysis results will be provided.

5.1 Discussion of the hierarchy of causes of scaffolding accidents

Lack/inadequate guardrails were found to be the major cause of scaffolding accidents. A total of 59% of the respondents concurred that the lack of guardrails was a major factor in the scaffolding accidents. This finding is interesting because guardrails can prevent and protect scaffolding users from falls and slips ( ILO, 1992 ). Major causes of slips and falls include wet floors, debris on floors, irregular surfaces and poor personal protective equipment (PPE) (like clothing, helmets, goggles or other garments or equipment designed to protect construction workers from injury or infection). Research in the UK revealed that the main causes of accidents and injuries are due to slips and falls ( Construction Manager, 2019 ). A lack of “edge protection” is a major cause of scaffolding accidents on many Norwegian construction sites. Many of the workers “forgot” that there was no edge protection on the scaffolding ( Winge and Albrechtsen, 2018 ). The research also found that improper assembling of scaffolding is a major cause of accidents. Not only should the scaffolding components be fastened together, but they should also be adequately assembled to avoid collapsing if loads are placed on them. This is because if scaffoldings are poorly assembled, the scaffolding may not be stable. Haslam et al. (2005) found that several construction injuries in the UK were due to the operatives striking their body parts against protrusions, mainly caused by the poor assembly of scaffoldings. Hence, scaffolding should not be assembled without the presence and supervision of a competent person ( ILO, 1992 ). Many scaffolding accidents occur due to poor assembly or lack of supervision during its erection. It is found that poor safety cultures of construction are responsible for many falls, which lead to fatal accidents ( Hamdan and Awang, 2015 ). Therefore, it was anticipated to find that many scaffolding accidents were due to poor safety cultures. A total of 53% of the respondents measured that poor safety culture was a major reason for scaffolding accidents. Related to the lack of safety culture as a good reason for scaffolding accidents was scaffolding users' attitude. The survey revealed that poor attitudes toward scaffolding safety were the fifth causal factor of scaffolding accidents, and 51% believed it was the main cause. This finding is similar to a conclusion reached on Norwegian construction sites ( Winge and Albrechtsen, 2018 ).

5.2 Discussion of the factor analysis on the causes of scaffolding accidents

Second-order factor analysis for each component revealed that the causes were related to their respective component. Behaviours (1) of the workers constituted the major factor leading to scaffolding accidents. In other words, attitudinal behaviour-related elements rather than structural or technical elements were the major causes of scaffolding accidents. Apart from operatives' behaviours, the experience of the operatives (2) was also critical. Imperatively, it is one argument to have correct attitudes, but without experience, accident-free notions may not be possible. This is logical, as experiences and attitudes are interwoven. However, experiences and behaviours are related to the quality and completeness of the scaffolding itself. Therefore, it is not surprising that structure is the 3rd component. Missing parts or incorrect assembly of the scaffolding would lead to accidents ( Gürcanli and Müngen, 2013 ) regardless of the experience and behaviours of the site operatives. This will especially be the case if the capacity (4) of the scaffolding is not determined and excessive loads are placed on the scaffolding. General is the fifth component. The second-order factor analysis reclassified the six causes into two sub-components; the first sub-component comprised no guardrails installed on scaffolding, unsecured planking and no life on lifeline scaffolding; the second sub-component involved improper leaning against scaffolding, bad weather and misjudgements of hazardous conditions. The investigation of the sub-factors showed that they were highly related at the sub-component level. To illustrate, operatives that underestimated the extent of risks on scaffolding tended to lean on scaffolding, and it is not safe to work on scaffolding when the weather is bad. Furthermore, research has shown that most scaffolding accidents occur during the rainy season or at night or in the latter part of the evening. “PPE” is the sixth major component in the variance. While PPE is meant to protect operatives, if the PPE is not available or not used properly, it will lead to accidents. While the designer teams can collectively reduce scaffolding accidents, a significant amount of responsibility lies with the contractor organizations. To summarize, most of the causes of accidents stem from the culture of those working on sites and the construction organizations' health and safety practices.

5.3 Discussion of the hierarchy of remedies for scaffolding accidents

The results revealed that the ARI classified the remedies into two classes. The first remedy to prevent scaffolding accidents was installing safety nets, and the second remedy was installing guardrails. The results were anticipated as both were protective measures and, in fact, complementary to each other. Aneziris et al. (2012) suggested using the net as one of the main measures to protect workers from falling objects. Guardrails should be provided as far as practicable on all scaffolding. However, where guardrails and toe-boards cannot be provided, adequate safety nets or safety sheets should be provided. While guardrails are an active method to prevent workers from falling, a safety net is a passive method because it is meant to reduce injuries after falls. This finding is interesting because guardrails are usually provided on scaffolding more than 4 m above the ground level in Malaysia. The government-sponsored committee recommends that guardrails be provided on the scaffolding at 2 metres and above ( CIDB, 2018 ).

It is not surprising that “assemble scaffolding properly” was rated 3rd because it was rated as a significant cause of scaffolding accidents. Therefore, this finding confirms the importance of assembling scaffolding to reduce accidents and claims and increase productivity. Poor or defective materials/components should not be used to construct scaffolding parts and accessories. Because scaffolding needs to perform its designed functions, high-quality components and accessories should be used on scaffolding. Again, PPE is regarded as a major remedy for reducing scaffolding accidents. This is consistent with Keng and Abdul Razak's (2014) and Ulang et al. 's (2014) findings. These studies show that using PPE will reduce accidents on sites. However, PPEs must be correctly used ( Aneziris et al. , 2012 ). Unsuitable PPE will lead to accidents and injuries. Scaffolding should be assembled and certified by a competent person (i.e. qualified safety officers/supervisors ( Keng and Abdul Razak, 2014 ). Access should not be given if scaffolding is not well assembled. Multiple agencies may require certifications for a big project, like the firefighting department, work departments and manufacturers. It serves to underscore the importance of a competent person in the erection and use of the scaffolding. For instance, in Malaysia, the MS 1462 standard stipulated that scaffolding should not be used until certified by a Chief Inspector.

5.4 Discussion of the results of the factor analysis of the remedies

Factor analysis grouped the remedies into six components. Poor assembly (1) of scaffolding components denominated the remedial measure “scaffolding”. A lack of guardrails, lifelines, PPEs and the poor assembly of guardrails will lead to accidents or will complicate accidents when they occur. For instance, many scaffolding collapses on construction sites due to the poor assembly of guardrails, lifelines and lack of PPE will increase fatalities. However, even if scaffolding is adequately assembled, accidents can occur due to other reasons. For instance, the workers may be vulnerable without adequate guardrails, lifelines or PPEs. Therefore, proper testing (2) is required to avoid breakdowns and accidents. Inspection of scaffolding and other tools for safety will reduce accidents on construction sites. The “behavioural” component (3) has diverse yet related remedies. Sites with proper supervision with competent staff that have knowledge of scaffolding would be able to determine the safe loading of the scaffolding. They will also likely use preventive measures like safety nets and ensure that scaffoldings adhere to all regulations and standards. A regulation [framework] is the fourth component. There are many regulations and standard operating procedures to reduce scaffolding accidents ( CIDB, 2018 ). However, implementations are always difficult. To deduce this difficulty, contractors could develop in-house regulations to ensure open communication among site operatives to ensure that those that violate the guideline on the erection and operation of the scaffolding are penalized. Scaffoldings, like other equipment or tools on-site, have definite lifespans. Scaffolding components wear and tear at different rates and times. Therefore, a proactive maintenance strategy (5th component) must be developed for routine and corrective repairs. Decisions have to be made if maintenance is to be outsourced or performed by the in-house organization. However, a well-developed in-house maintenance policy will be more rewarding, especially for the big contractors. Furthermore, contractor organizations need to provide training (6th component) to operatives on preventing scaffolding accidents and accident reporting procedures. This may be in the form of a simple flow chart that indicates how to make a specific report and who to report an accident to. A complex reporting system can create more problems as operatives may not want to conduct reports. Thus, some may not make reports if the accidents are not fatal. Technology can also be used to monitor the performance and safety of scaffolding.

6. Research implications and causation framework

Scaffolding users, supervisors and construction managers do not perform scaffolding inspections, repairs and maintenance proactively but rather reactively.

Implicit in the findings of this research were that scaffolding accidents were due to behavioural issues of the site workers and contractor organizations.

There is a lack of enforcement and low fines imposed on errant violators by the government. Contractors, governments, policies, consultants and clients only take scaffolding seriously when deaths or fatal accidents occur. This only lasts for a short term, after which activities return to business as usual.

Many of the construction companies do not have safety policies, and government regulations are not well formulated and enforced, especially on sites. However, the current measures to address health and safety on Malaysian construction sites are very prescriptive because they depend on regulations.

Safety and health measures should be a precondition to site construction management and should be included in the method statement.

Deductively, Figure 4 displays a causation framework of the impacts of unhealthy and safe practices. As the figure demonstrates, addressing the human factors would help reduce scaffolding accidents because errors, faults, oversights, negligence and mistakes are the main contributing factors for scaffolding related to construction sites. Unsafe human behaviour at construction sites is the main cause of the health and safety problems on the construction sites. Hence, influencing the behaviours of site operatives concerning health and safety represents the most systemic approach to reducing accidents and fatalities at construction sites. Regulations, policies, complicated techniques and systems can only play complementary roles, not the main roles.

7. Conclusion and recommendations for site operatives

Scaffolding accidents are rampant on sites, and many have been injured while using scaffolding. All the 24 causes would lead to accidents on the sites. The primary causes are lack of guardrails on scaffoldings, poor inspections of scaffolding, improper assembly of scaffolding, poor safety culture and ignorance of the safety procedures by operatives. The primary causes are related to the safety culture of the construction organizations. There is a need to change the sector's attitudes to health and safety management.

The effective remedies to reduce or avoid scaffolding accidents include installing a safety net, installing proper guardrails, correctly assembling scaffoldings, quality components and providing proper PPE to site operatives. Inductively, addressing the sites' attitudes and behaviours would help minimize scaffolding-related accidents on sites. Reactive measures are dominant among construction organizations.

Government agencies should conduct unscheduled inspections to ensure that construction companies adhere to regulations and policies. This will complement the safety culture of the site operatives and the construction organizations.

The limitation of this study due to the small sample size may necessitate future research to increase the sample size. In addition, more causes and remedies may be included.

The causation framework requires verification and validation to measure its suitability for reducing scaffolding accidents on construction sites.

Future research should differentiate between the causes of accidents and remedies for new construction and maintenance/refurbishment projects.

Respondent's profile

Scree plot and variance explained of the causes

Scree plot and variance explained of the remedies

Olan's accident causation framework for health and safety practices

Summary of factors causing scaffolding accidents on construction sites

Summary of remedies to reduce scaffolding accidents in the construction sites

Incidence of accidents and injury on site

Descriptive statistics of the causes of scaffolding accidents

Distribution of rotated factor pattern

Descriptive statistics of the remedies of scaffold accidents

Distribution of Rotated Factor Pattern of the remedies

Abas , N.H. , Noridan , M.R. , Rahmat , M.H. , Abas , N.A. and Ibrahim , N.Q. ( 2020 ), “ Causes of accidents involving scaffolding at construction sites ”, Journal of Technology Management and Business , Vol. 7 No. 1 , pp. 75 - 86 .

Abu Bakar , N.A. , Ismail , M.R. and Lin , T.G. ( 2008 ), “ Scaffolding safety assessment in construction sites in Penang ”, 2nd International Conference on Built Environment In Developing Countries (ICBEDC 2008) , pp. 1311 - 1328 .

Ali , A. , Kamaruzzaman , S. and Sing , G. ( 2010 ), “ A study on causes of accident and prevention in Malaysian construction industry ”, Journal Design + Built , Vol. 3 , pp. 95 - 104 .

Aneziris , O.N. , Topali , E. and Papazoglou , I.A. ( 2012 ), “ Occupational risk of building construction ”, Reliability Engineering and System Safety , Vol. 105 , pp. 36 - 46 .

Awwad , R. , El Souki , O. and Jabbour , M. ( 2016 ), “ Construction safety practices and challenges in a Middle Eastern developing country ”, Safety Science , Vol. 83 , pp. 1 - 11 .

Ayob , A. , Shaari , A.A. , Zaki , M.F.M. and Munaaim , M.A.C. ( 2018 ), “ Fatal occupational injuries in the Malaysian construction sector–causes and accidental agents ”, IOP Conference Series: Earth and Environmental Science , IOP Publishing , Vol. 140 No. 1 , p. 012095 .

Bakar , H. ( 2018 ), Occupational and Commuting Accidents in Malaysia: Protection and Prevention , NCOSH Seminar2018, Sherwood Gateway Hotel , Bangi , available at: http://www.dosh.gov.my/index.php/competent-person-form/occupational-health/dosh-event/3100-1-statistik-kemalangan-penyakit-pekerjaan-perkeso-di-sektor-pks-dan-impak-kepada-negara/file ( accesesd November 2015 ).

Bennett , P. , Rooney , A. , Walpole , G. and Whiting , R. ( 2018 ), Work at Height: 4 Experts on How to Reduce Accidents , Retrieved from CIOB available at: http://www.constructionmanagermagazine.com/opinion/work-height-4-experts-how-reduce-accidents/ .

Bureau of Labor Statistics (BLS) ( 2012 ), Fatal Occupational Injuries and Workers' Memorial Day. BLS 2010 Survey of Occupational Injuries, Illness and Fatalities , U.S. Dept. of Labor , Washington, DC , available at : http://www.bls.gov/iif/ ( accesesd 25 April 12 ).

Chi , C.F. , Chang , T.C. and Ting , H.I. ( 2005 ), “ Accident patterns and prevention measures for fatal occupational falls in the construction industry ”, Applied Ergonomics , Vol. 36 No. 4 , pp. 391 - 400 .

Chong , H.Y. and Low , T.S. ( 2014 ), “ Accidents in Malaysian construction sector: statistical data and court cases ”, International Journal of Occupational Safety and Ergonomics , Vol. 20 No. 3 , pp. 503 - 513 .

CIDB (Construction Sector Development Board Malaysia ( 2018 ), Securing Improvement in the Health and Safety Performance of Malaysia's Construction Sector CIDB Technical Publication , CIDB Malaysia , Kuala Lumpur , Vol. 183 , 978-967-0997-31-5 .

CIDB Malaysia ( 2009 ), Construction Industry Standard: Guidelines on Prevention of Fall at Construction Site , CIDB Malaysia , Kuala Lumpur .

Collins , R. , Zhang , S. , Kim , K. and Teizer , J. ( 2014 ), “ Integration of safety risk factors in BIM for scaffolding construction ”, Computing in Civil and Building Engineering (2014) , pp. 307 - 314 .

Construction Managers ( 2019 ), Scaffolding Contractors Report Spike in Accidents , available at : www.constructionmanagermagazine.com/news/scaffolding-contractors-report-spike-accidents/ ( accessed 26 April 2019 ).

Czarnocka , E. , Bojar , H. , Szaniawska , K. and Czarnocki , K.J. ( 2020 ), “ Worker visual concentration as risk factor of work on scaffolding ”, Occupational and Environmental Safety and Health II , Vol. 277 , p. 93 .

Dogan , E. , Yurdusev , M.A. , Yildizel , S.A. and Calis , G. ( 2021 ), “ Investigation of scaffolding accident in a construction site: a case study analysis ”, Engineering Failure Analysis , Vol. 120 , p. 105108 .

Eurostat (Statistics Explained ( 2019 ), Accidents at Work - Statistics on Causes and Circumstances , available at : https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Accidents_at_work_-_statistics_on_causes_and_circumstances#Cause_of_accident ( accessed 26 November 2019 ).

Global Construction Review ( 2021 ), Under-construction School Collapse Kills Five Workers in Antwerp , available at : https://www.globalconstructionreview.com/news/under-construction-school-collapse-kills-five-work/ ( accessed 21 June 2021 ).

Goetsch , D. ( 2013 ), Construction Safety and Health , 2nd ed. , Pearson , Upper Saddle River, New Jersey, NJ .

Gürcanli , G.E. and Müngen , U. ( 2013 ), “ Analysis of construction accidents in Turkey and responsible parties ”, Industrial Health , Vol. 53 , pp. 2012 - 0139 .

Halperin , K. and McCann , M. ( 2004 ), “ An evaluation of scaffold safety at construction sites ”, Journal of Safety Research , Vol. 35 , pp. 141 - 150 .

Hamdan , N. and Awang , H. ( 2015 ), “ Safety scaffolding in the construction site ”, Jurnal Teknologi , Vol. 75 No. 5 , pp. 26 - 31 .

Haslam , R.A. , Hide , S.A. , Gibb , A.G. , Gyi , D.E. , Pavitt , T. , Atkinson , S. and Duff , A.R. ( 2005 ), “ Contributing factors in construction accidents ”, Applied Ergonomics , Vol. 36 No. 4 , pp. 401 - 415 .

Heckmann , J.V. ( 1995 ), Analysis of Accidents Related to Scaffolding and Floor/Wall Openings , University of Washington , Washington .

Howarth , T. and Watson , P. ( 2009 ), Construction Safety Management , Wiley-Blackwell , Oxford .

Hoła , A. , Sawicki , M. and Szóstak , M. ( 2018 ), “ Methodology of classifying the causes of occupational accidents involving construction scaffolding using Pareto-Lorenz analysis ”, Applied Sciences , Vol. 8 No. 1 , p. 48 .

HSE (Health and Safety Executive ( 2019b ), Costs to Britain of Workplace Fatalities and Self Reported Injuries and Ill Health , available at: http://www.hse.gov.uk/statistics/cost.htm ( accessed 27 November 2019 ).

ILO (International Labour Office ( 1992 ), Safety and Health in Construction: an ILO Code of Practice , International Labour Office, International Labour Organization , Geneva , 92-2-107104-9 , 1992/Code of practice/,/Occupational safety/,/Occupational health/,/Construction sector/. 08.10.1 .

Ismail , H.B. and Ab Ghani , K.D. ( 2012 ), “ Potential hazards at the construction workplace due to temporary structures ”, Procedia-Social and Behavioral Sciences , Vol. 49 , pp. 168 - 174 .

Keng and Abdul Razak ( 2014 ), “ Case studies on the safety management at construction site ”, Journal of Sustainability Science and Management , Vol. 9 No. 2 , pp. 90 - 108 .

Lee , B.H.C. , Chen , J.C. and Fo , K.W. ( 2018 ), “ Accidents in construction sites: a study on the causes and preventive approaches to mitigate accident rate ”, INTI Journal , Vol. 1 No. 3 .

López , M.A.C. , Ritzel , D.O. , Fontaneda , I. and Alcantara , O.J.G. ( 2008 ), “ Construction sector accidents in Spain ”, Journal of Safety Research , Vol. 39 No. 5 , pp. 497 - 507 .

Lucas , G. ( 2018 ), “ Why the HSE is tackling construction workers' lung health ”, Construction Manager , available at : http://www.constructionmanagermagazine.com/news/why-hse-tackling-construction-workers-lung-health/ ( accessed 17 October 2018 ).

Nadhim , E. , Hon , C. , Xia , B. , Stewart , I. and Fang , D. ( 2016 ), “ Falls from height in the construction industry: a critical review of the scientific literature ”, International Journal of Environmental Research and Public Health , Vol. 13 No. 7 , p. 638 , doi: 10.3390/ijerph13070638 .

Oladiran , O.J. , Ogunsanmi , O.E. and Soyingbe , A.A. ( 2008 ), “ Control measures of accident: Nigerian building projects' case ”, Proceedings of CIB-2008-Transformation through Construction , pp. 15 - 17 .

Olanrewaju , A.L. and Abdul-Aziz , A.R. ( 2015 ), Building Maintenance Processes and Practices: the Case of a Fast-Developing Country , Springer .

Olanrewaju , A.L. and Idrus , A. ( 2020 ), “ What is determining affordable housing shortages in the Greater Kuala Lumpur, Malaysia? ”, Property Management , Vol. 38 No. 1 , pp. 52 - 81 , doi: 10.1108/PM-05-2019-0025 .

Olanrewaju , A. , Law , X.X. and Preece , N.C. ( 2021 ), in El Baradei , S. , Abodonya , A. , Singh , A. and Yazdani , S. (Eds), “ Evaluation of scaffold accidents during building maintenance works ”, Proceedings of International Structural Engineering and Construction , Vol. 8 No. 1 , p. 2021 , Interdisciplinary Civil and Construction Engineering Projects , available at: www.doi.org/10.14455/ISEC.2021.812644-108X .

OSHA (Occupational Safety and Health Administration ( 2019 ), Scaffolding: Construction , available at: https://www.osha.gov/SLTC/scaffolding/construction.html ( accessed 28 November 2019 ).

OSHD (The Occupational Safety and Health Division ( 2017 ), Annual Report 2017 Safe and Healthy Workplaces: Global Vision for Prevention , available at: https://www.mom.gov.sg/workplace-safety-and-health ( accessed 26 November 2019 ).

Pieńko , M. , Robak , A. , Błazik-Borowa , E. and Szer , J. ( 2018 ), “ Safety conditions analysis of scaffolding on construction sites ”, International Journal of Civil and Environmental Engineering , Vol. 12 No. 2 , pp. 93 - 98 .

Research and Markets ( 2020 ), World Construction Sector Size and Forecast to 2023 - Continuous Major Economic Growth in Various Developed and Emerging Markets Drives the Sector , available at: https://www.researchandmarkets.com/ .

Rubio-Romero , J.C. , Suárez-Cebador , M. , Pardo-Ferreira , M.D.C. , la Varga-Salto , D. , María , J. and Carrillo-Castrillo , J.A. ( 2019 ), “ Does Europe need an EU Product safety directive for access scaffolding? ”, International Journal of Environmental Research and Public Health , Vol. 16 No. 1 , p. 103 .

Sawacha , E. , Naoum , S. and Fong , D. ( 1999 ), “ Factors affecting safety performance on construction sites ”, International Journal of Project Management , Vol. 17 No. 5 , pp. 309 - 315 .

Schilling , R.D. ( 2013 ), Global Construction Expected to Increase by $4.8 Trillion by 2020 , available at: https://www.sectortap.com/global-construction-expected-to-increase-by-4-8-trillion-by-2020/1483 .

Social Security Organization Annual Report ( 2012–2016 ), Kuala Lumpur: PERKESO , available at: https://www.perkeso.gov.my/index.php/en/laporan/number-of-accidents .

Social Security Organization Annual Report ( 2018 ), Kuala Lumpur: PERKESO , available at: www.perkeso.gov.my .

Szóstak , M. , Hoła , B. and Bogusławski , P. ( 2021 ), “ Identification of accident scenarios involving scaffolding ”, Automation in Construction , Vol. 126 , 103690 .

The Institution of Engineers, Malaysia ( 2015 ), Revised Position Statement, Jan 2015 Prevention of Collapse of Part A: Scaffolding and Part B: Falsework .

Ulang , N.M. , Salim , N.S. , Baharum , F. and Salim , N.A. ( 2014 ), “ Construction site workers' awareness on using safety equipment: case study ”, MATEC Web of Conferences , Vol. 15 , p. 01023 , EDP Sciences .

Wang , P. , Wu , P. , Wang , X. , Chen , X. and Zhou , T. ( 2020 ), “ Developing optimal scaffolding erection through the integration of lean and work posture analysis ”, Engineering, Construction and Architectural Management , Vol. 27 No. 9 , pp. 2109 - 2133 , doi: 10.1108/ECAM-04-2019-0193 .

Williams , O.S. , Hamid , R.A. and Misnan , M.S. ( 2017 ), “ Analysis of fatal building construction accidents: cases and causes ”, Journal of Multidisciplinary Engineering Science and Technology (JMEST) , Vol. 4 No. 8 , pp. 8030 - 8040 .

Winge , S. and Albrechtsen , E. ( 2018 ), “ Accident types and barrier failures in the construction sector ”, Safety Science , Vol. 105 , pp. 158 - 166 .

Zhou , Z. , Goh , Y.M. and Li , Q. ( 2015 ), “ Overview and analysis of safety management studies in the construction sector ”, Safety Science , Vol. 72 , pp. 337 - 350 .

Further reading

CIBD Construction Sector Development Board Malaysia ( 2017 ), “ Safe use of scaffolding in construction ”, CIS , Vol. 22 , p. 2017 1st ed. , available at: http://www.cidb.gov.my/index.php/en/construction-info/standards ( accessed 21 November 2019 ).

CIOB Chartered Institute of Building ( 2006 ), Occupational Stress in the Construction Sector Survey 2006 , The Chartered Institute of Building , Berkshire .

Corresponding author

Related articles, all feedback is valuable.

Please share your general feedback

Report an issue or find answers to frequently asked questions

Contact Customer Support

The Straits Times

• International
• Print Edition
• news with benefits
• SPH Rewards
• STClassifieds
• Berita Harian
• Hardwarezone
• Shin Min Daily News
• Tamil Murasu
• The Business Times
• The New Paper
• Lianhe Zaobao
• Advertise with us

Scaffolding collapse at Malaysian highway construction site injures two

PETALING JAYA (THE STAR/ASIA NEWS NETWORK) - Two construction workers were injured after metal scaffolding of a highway that was under construction in Malaysia collapsed on Saturday (June 19).

The incident was reported along the Sungai Buloh - Kota Damansara stretch of the North Klang Valley Expressway (NKVE) on the outskirt of Kuala Lumpur at 7.14pm.

Two Bangladeshi workers who were on duty underneath the 12 metre-tall construction site suffered light injuries, said Selangor Fire and Rescue Department director Norazam Khamis, in a report by Sinar Harian.

"The two victims were in their 20s and 40s," he said in the report.

Mr Norazam added that no one else was hurt.

Meanwhile, Projek Lintasan Kota Holdings (Prolintas), a developer of the highway, confirmed the incident, saying the two workers were brought to the Sungai Buloh hospital for treatment.

"This incident did not involve other highway users or other members of the public because it occurred within an enclosed construction area," Prolintas said in a statement on Saturday.

It said a stop-work order at the construction site was issued immediately.

"The developer and main contractor involved will give their full cooperation to the relevant parties for any investigations.

"We will issue follow up statements on this incident from time to time," added Prolintas.

Join ST's Telegram channel and get the latest breaking news delivered to you.

• Construction sector

Read 3 articles and stand to win rewards

Spin the wheel now

• Open access
• Published: 26 August 2024

Solid health care waste management practice in Ethiopia, a convergent mixed method study

• Yeshanew Ayele Tiruneh 1 ,
• L. M. Modiba 2 &
• S. M. Zuma 2  

BMC Health Services Research volume  24 , Article number:  985 ( 2024 ) Cite this article

Metrics details

Introduction

Healthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods.

This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town.

A mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town.

Seventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ‘‘ the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market’’ . The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus.

Hand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.

Peer Review reports

Healthcare waste (HCW) encompasses all types of waste generated while providing health-related services, spanning activities such as diagnosis, immunization, treatment, and research. It constitutes a diverse array of materials, each presenting potential hazards to health and the environment. Within the realm of HCW, one finds secretions and excretions from humans, cultures, and waste containing a stock of infectious agents. Discarded plastic materials contaminated with blood or other bodily fluids, pathological wastes, and discarded medical equipment are classified as healthcare waste. Sharps, including needles, scalpels, and other waste materials generated during any healthcare service provision, are also considered potentially hazardous to health [ 1 ].

Healthcare waste in solid form (HCW) is commonly divided into two primary groups: infectious and non-infectious. The existence of pathogens in concentrations identifies infectious waste or amounts significant enough to induce diseases in vulnerable hosts [ 1 ] If healthcare facility waste is free from any combination with infectious agents, nearly 85% is categorized as non-hazardous waste, exhibiting characteristics similar to conventional solid waste found in households [ 2 ]. World Health Organization (WHO) recommends that appropriate colour-coded waste receptacles be available in all medical and other waste-producing areas [ 3 ].

Solid waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Improper disposal of sharps waste increases the risk of disease transmission among health facility workers and general populations [ 1 ]. Inadequate and inappropriate handling of healthcare waste may have serious public health consequences and a significant environmental impact. The World Health Organization (2014) guidelines also include the following guidance for hand washing and the use of alcohol-based hand rubs: Wash hands before starting work, before entering an operating theatre, before eating, after touching contaminated objects, after using a toilet, and in all cases where hands are visibly soiled [ 4 ].

Among the infectious waste category, sharps waste is the most hazardous waste because of its ability to puncture the skin and cause infection [ 3 ]. Accidents or occurrences, such as near misses, spills, container damage, improper waste segregation, and incidents involving sharps, must be reported promptly to the waste management officer or an assigned representative [ 5 ].

Africa is facing a growing waste management crisis. While the volumes of waste generated in Africa are relatively small compared to developed regions, the mismanagement of waste in Africa already impacts human and environmental health. Infectious waste management has always remained a neglected public health problem in developing countries, resulting in a high burden of environmental pollution affecting the general masses. In Ethiopia, there is no updated separate regulation specific to healthcare waste management in the country to enforce the proper management of solid HCW [ 6 ].

In Ethiopia, like other developing countries, healthcare waste segregation practice was not given attention and did not meet the minimum HCWM standards, and it is still not jumped from paper. Previous study reveals that healthcare waste generation rates are significantly higher than the World Health Organization threshold, which ranges from 29.5–53.12% [ 7 , 8 ]. In Meneilk II Hospital, the proportion of infectious waste was 53.73%, and in the southern and northern parts of Ethiopia, it was 34.3 and 53%, respectively. Generally, this figure shows a value 3 to 4 times greater than the threshold value recommended by the World Health Organization [ 7 ].

Except for sharp wastes, segregation practice was poor, and all solid wastes were collected without respecting the colour-coded waste disposal system [ 9 ]. The median waste generation rate was found to vary from 0.361- 0.669 kg/patient/day, comprising 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated increased as the number of patients flow increased. Public hospitals generated a high proportion of total healthcare waste (59.22%) in comparison with private hospitals (40.48) [ 10 ]. The primary SHCW treatment and disposal mechanism was incineration, open burning, burring into unprotected pits and open dumping on municipal dumping sites as well as in the hospital backyard. Carelessness, negligence of the health workers, patients and cleaners, and poor commitment of the facility leaders were among the major causes of poor HCWM practice in Ethiopia [ 9 ]. This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia.

The setting for this study was all health facilities found in Hossaena town, which is situated 232 kms from the capital city of Ethiopia, Addis Ababa, and 165 kms from the regional municipality of Hawasa. The health facilities found in the town were one university hospital, one private surgical centre, three government health centres, 17 medium clinics, and 19 small clinics were available in the city and; health facility workers who have direct contact with generating and disposal of HCW and those who are responsible as a manager of health facilities found in Hossaena town are the study settings. All health facilities except drug stores and health facility workers who have direct contact with healthcare waste generation participated in this study.

A mixed-method study design was used. For the quantitative part of this study, all healthcare workers who have direct contact with healthcare waste management practice participated in this study, and one focus group discussion from each health facility was used. Both of the study participants were taken from the same population. All health facility workers who have a role in healthcare waste management practice were included in the quantitative part of this study. The qualitative data collection phase used open-ended interviews, focus group discussions, and visual material analysis like posters and written materials. All FGDs were conducted by the principal investigator, one moderator, and one note-taker, and it took 50 to 75 min. 4–6 participants participated in each FGD.

According to Elizabeth (2018: 5), cited by Creswell and Plano (2007: 147), the mixed method is one of the research designs with philosophical assumptions as well as methods of inquiry. As a method, it focuses on collecting, analyzing, and mixing both quantitative and qualitative data in a single study. As a methodology, it involves philosophical assumptions guiding the direction of the collection and analysis and combining qualitative and quantitative approaches in many phases of the research project. The central premise is that using qualitative and quantitative approaches together provides a better understanding of the research problems than either approach alone.

The critical assumption of the concurrent mixed methods approach in this study is that quantitative and qualitative data provide different types of information, often detailed views of participants’ solid waste management practice qualitatively and scores on instruments quantitatively, and together, they yield results that should be the same. In this approach, the researcher collected quantitative and qualitative data almost simultaneously and analyzed them separately to cross-validate or compare whether the findings were similar or different between the qualitative and quantitative information. Concurrent approaches to the data collection process are less time-consuming than other types of mixed methods studies because both data collection processes are conducted on time and at the same visit to the field [ 11 ].

Data collection

The data collection involves collecting both quantitative and qualitative data simultaneously. The quantitative phase of this study assessed three components. Health care waste segregation practice, the availability of waste segregation equipment for HCW segregation, temporary storage facilities, transportation for final disposal, and disposal facilities data were collected using a structured questionnaire and observation of HCW generation. Recycling or re-using practice, waste treatment, the availability of the HCWM committee, and training data were collected.

Qualitative data collection

The qualitative phase of the data collection for this study was employed by using focus group discussions and semi-structured interviews about SHCWMP. Two focus group discussions (FGD) from each health facility were conducted in the government health facilities, one at the administrative level and one at the technical worker level, and one FGD was conducted for all private health facilities because of the number of available health facility workers. Each focus group has 4–6 individuals.

In this study, the qualitative and the quantitative data provide different information, and it is suitable for this study to compare and contrast the findings of the two results to obtain the best understanding of this research problem.

Quantitative data collection

The quantitative data were entered into Epi data version 3.1 to minimize the data entry mistakes and exported to the statistical package for social science SPSS window version 27.0 for analysis. A numeric value was assigned to each response in a database, cleaning the data, recoding, establishing a codebook, and visually inspecting the trends to check whether the data were typically distributed.

Data analysis

Data were analyzed quantitatively by using relevant statistical tools, such as SPSS. Descriptive statistics and the Pearson correlation test were used for the bivariate associations and analysis of variance (ANOVA) to compare the HCW generation rate between private and government health facilities and between clinics, health centres and hospitals in the town. Normality tests were performed to determine whether the sample data were drawn from a normally distributed population.

The Shapiro–Wilk normality tests were used to calculate a test statistic based on the sample data and compare it to critical values. The Shapiro–Wilk test is a statistical test used to assess whether a given sample comes from a normally distributed population. The P value greater than the significance level of 0.05 fails to reject the null hypothesis. It concludes that there is not enough evidence to suggest that the data does not follow the normal distribution. Visual inspection of a histogram, Q-Q plot, and P-P plot (probability-probability plot) was assessed.

Bivariate (correlation) analysis assessed the relationships between independent and dependent variables. Then, multiple linear regression analysis was used to establish the simple correlation matrices between different variables for investigating the strength relationships of the study variables in the analysis. In most variables, percentages and means were used to report the findings with a 95% confidence interval. Open-ended responses and focused group findings were undertaken by quantifying and coding the data to provide a thematic narrative explanation.

Appropriate and scientific care was taken to maintain the data quality before, during, and after data collection by preparing the proper data collection tools, pretesting the data collection tools, providing training for data collectors, and proper data entry practice. Data were cleaned on a daily basis during data collection practice, during data entry, and before analysis of its completeness and consistency.

Data analysis in a concurrent design consists of three phases. First, analyze the quantitative database in terms of statistical results. Second, analyze the qualitative database by coding the data and collapsing the codes into broad themes. Third comes the mixed-method data analysis. This is the analysis that consists of integrating the two databases. This integration consists of merging the results from both the qualitative and the quantitative findings.

Descriptive analysis was conducted to describe and summarise the data obtained from the samples used for this study. Reliability statistics for constructs, means and modes of each item, frequencies and percentage distributions, chi-square test of association, and correlations (Spearman rho) were used to portray the respondents’ responses.

All patient care-providing health facilities were included in this study, and the generation rate of healthcare waste and composition assessed the practice of segregation, collection, transportation, and disposal system was observed quantitatively using adopted and adapted structured questionnaires. To ensure representativeness, various levels of health facilities like hospitals, health centres, medium clinics, small clinics and surgical centres were considered from the town. All levels of health facilities are diagnosing, providing first aid services and treating patients accordingly.

The hospital and surgical centre found in the town provide advanced surgical service, inpatient service and food for the patients that other health facilities do not. The HCW generation rate was proportional to the number of patients who visited the health facilities and the type of service provided. The highest number of patients who visited the health facilities was in NEMMCSH; the service provided was diverse, and the waste generation rate was higher than that of other health facilities. About 272, 18, 15, 17, and 20 average patients visited the health facilities daily in NEMMCSH: government health centres, medium clinics, small clinics, and surgical centres. Paper and cardboard (141.65 kg), leftover food (81.71 kg), and contaminated gloves (42.96 kg) are the leading HCWs generated per day.

A total of 556 individual respondents from sampled health facilities were interviewed to complete the questionnaire. The total number of filled questionnaires was 540 (97.1) from individuals representing these 41 health facilities.

The principal investigator observed the availability of handwashing facilities near SHCW generation sites. 17(3.1%) of health facility workers had hand washing facilities near the health care waste generation and disposal site. Furthermore,10 (3.87%), 2 (2.1%), 2 (2.53%), 2 (2.1%), 1 (6.6%) of health facility workers had the facility of hand washing near the health care waste generation site in Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH), government health centres, medium clinics, small clinics, and surgical centre respectively. This finding was nearly the same as the study findings conducted in Myanmar; the availability of hand washing facilities near the solid health care waste generation was absent in all service areas [ 12 ]. The observational result was convergent with the response of facility workers’ response regarding the availabilities of hand washing facilities near to the solid health care waste generation sites.

The observational result was concurrent with the response of facility workers regarding the availability of hand-washing facilities near the solid health care waste generation sites.

The availability of personal protective equipment (PPE) was checked in this study. Three hundred ninety-two (72.6%) of the respondents agree on the facility’s availability of one or more personal protective equipment (PPE). The availability of PPEs in different levels of health facilities shows 392 (72.6%), 212 (82.2%), 56 (58.9%), 52 (65.8%), 60 (65.2%), 12 (75%) health facility workers in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively agree to the presence of personal protective equipment in their department. The analysis further shows that the availability of masks for healthcare workers was above the mean in NEMMCSH and surgical centres.

Focus group participants indicated that health facilities did not volunteer to supply Personal protective equipment (PPEs) for the cleaning staff.

“We cannot purchase PPE by ourselves because of the salary paid for the cleaning staff.”

Cost inflation and the high cost of purchasing PPEs like gloves and boots are complained about by all (41) health facility owners.

“the reason for the absence of some of the PPEs like boots, goggles, and shortage of disposable gloves are owing to cost inflation from time to time and sometimes absent from the market is the reason why we do not supply PPE to our workers.”

Using essential personal protective equipment (PPEs) based on the risk (if the risk is a splash of blood or body fluid, use a mask and goggles; if the risk is on foot, use appropriate shoes) is recommended by the World Health Organization [ 13 ]. The mean availability of gloves in health facilities was 343 (63.5% (95% CI: 59.3–67.4). Private health institutions are better at providing gloves for their workers, 67.1%, 72.8%, and 62.5% in medium clinics, small clinics, and surgical centres, respectively, which is above the mean.

Research participants agree that.

‘‘ there is a shortage of gloves to give service in Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH) and government health centres .’’

Masks are the most available personal protective equipment for health facility workers compared to others. 65.4%, 55.6%, and 38% of the staff are available with gloves, plastic aprons and boots, respectively.

The mean availability of masks, heavy-duty gloves, boots, and aprons was 71.1%, 65.4%, 38%, and 44.4% in the study health facilities. Health facility workers were asked about the availability of different personal protective equipment, and 38% of the respondents agreed with the presence of boots in the facility. Still, the qualitative observational findings of this study show that all health facility workers have no shoes or footwear during solid health care waste management practice.

SHCW segregation practice was checked by observing the availability of SHCW collection bins in each patient care room. Only 4 (1.7%) of the room’s SHCW bins are collected segregated (non-infectious wastes segregated in black bins and infectious wastes segregated in yellow bins) based on the World Health Organization standard. Colour-coded waste bins, black for non-infectious and yellow for infectious wastes, were available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. Only 6.7% of the waste bins were pedal operated and adequately covered, and the rest were fully opened, or a tiny hole was prepared on the container’s cover. All of the healthcare waste disposal bins in each health facility and at all service areas were away from the arm’s reach distance of the waste generation places, and this is contrary to World Health Organization SHCWM guidelines [ 13 ]. The observation result reveals that the reason for the above result was that medication trolleys were not used during medication or while healthcare providers provided any health services to patients.

Most medical wastes are incinerated. Burning solid and regulated medical waste generated by health care creates many problems. Medical waste incinerators emit toxic air pollutants and ash residues that are the primary source of environmental dioxins. Public concerns about incinerator emissions and the creation of federal regulations for medical waste incinerators are causing many healthcare facilities to rethink their choices in medical waste treatment. Health Care Without Harm [ 14 ], states that non-incineration treatment technologies are a growing and developing field. The U.S. National Academy of Science 2000 argued that the emission of pollutants during incineration is a potential risk to human health, and living or working near an incineration facility can have social, economic, and psychological effects [ 15 ].

The incineration of solid healthcare waste technology has been accepted and adopted as an effective method in Ethiopia. Incineration of healthcare waste can produce secondary waste and pollutants if the treatment facilities are not appropriately constructed, designed, and operated. It can be one of the significant sources of toxic substances, such as polychlorinated dibenzo-dioxins/dibenzofurans (PCDD/ PCDF), polyvinyl chloride (PVC), hexachlorobenzenes and polychlorinated biphenyls, and dioxins and furans that are known as hazardous pollutants. These pollutants may have undesirable environmental impacts on human and animal health, such as liver failure and cancer [ 15 , 16 ].

All government health facilities (4 in number) used incineration to dispose of solid waste. 88.4% and 100% of the wastes are incinerated in WUNEMMCSH and government health centres. This finding contradicts the study findings in the United States of America and Malaysia, in which 49–60% and 59–60 were incinerated, respectively, and the rest were treated using other technologies [ 15 , 16 ].

World Health Organization (2014:45) highlighted those critical elements of the appropriate operation of incinerators include effective waste reduction and waste segregation, placing incinerators away from populated areas, satisfactory engineered design, construction following appropriate dimensional plans, proper operation, periodic maintenance, and staff training and management are mandatory.

Solid waste collection times should be fixed and appropriate to the quantity of waste produced in each area of the health care facility. General waste should not be collected simultaneously or in the same trolley as infectious or hazardous wastes. The collection should be done daily for most wastes, with collection timed to match the pattern of waste generation during the day [ 13 ].

SHCW segregation practices were observed for 240 rooms in 41 health facilities that provide health services in the town. In government health centres, medium clinics, small clinics, and surgical centres, SHCW segregation practice was not based on the World Health Organization standard. All types of solid waste were collected in a single container near the generation area, and there were no colour-coded SHCW storage dust bins. Still, in NEMMCSH, in most of the service areas, colour-coded waste bins are available, and the segregation practice was not based on the standard. Only 3 (10%) of the dust bins collected the appropriate wastes according to the World Health Organization standard, and the rest were mixed with infectious and non-infectious SHCW.

Table 1 below shows health facility managers were asked about healthcare waste segregation practices, and 9 (22%) of the facility leaders responded that there is an appropriate solid healthcare waste segregation practice in their health facilities. Still, during observation, only 4 (1.7%) of the rooms in two (4.87%) of the facilities, SHCW bins collected the segregated wastes (non-infectious wastes segregated at the black bin and infectious wastes segregated at yellow bin) based on the world health organization standard. The findings of this study show there is a poor segregation practice, and all kinds of solid wastes are collected together.

In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. During observation in one of the study health facilities, infectious wastes were not collected daily and left for days. Utility gloves, boots, and aprons are not available for cleaning staff to collect and transport solid healthcare wastes in all study health facilities. 29.26% of the facilities’ cleaning staff have a face mask, and 36.5% of the facilities remove waste bins from the service area when 3/4 full, and the rest were not removed or replaced with new ones. There is a separate container only in 2 health facilities for infectious and non-infectious waste segregation practice, and the rest were segregated and collected using single and non-colour coded containers.

At all of the facilities in the study area, SHCW was transported from the service areas to the disposal site were transported manually by carrying the collection container and there is no trolley for transportation. This finding was contrary to the study findings conducted in India, which show segregated waste from the generation site was being transported through the chute to the carts placed at various points on the hospital premises by skilled sanitary workers [ 17 ].

Only 2 out of 41 health facilities have temporary solid waste storage points at the facility. One of the temporary storage places was clean, and the other needed to be properly cleaned and unsightly. Two (100%) of the temporary storage areas are not fenced and have no restriction to an authorized person. Temporary storage areas are available only in two health facilities that are away from the service provision areas.

Observational findings revealed that pre-treatment of SHCW before disposal was not practised at all study health facilities. 95% of the facilities have no water supply for hand washing during and after solid healthcare waste generation, collection, and disposal.

The United States Agency estimated sharp injuries from medical wastes to health professionals and sanitary service personnel for toxic substances and disease registry. Most of the injuries are caused during the recapping of hypodermic needles before disposal into sharps containers [ 13 ]. Nearly half of the respondents, 245 (51.5%), are recapping needles after providing an injection to the patient. Recapping was more practised in NEMMCSH and surgical centres, which is 57.5% and 57.5%, respectively. In government health centres, medium clinics, and surgical centres, the recapping of used needles was practised below the mean, which is 47.9%, 48, and 43.8%, respectively. This finding was reasonable compared to the study findings of Doylo et al. [ 18 ] in western Ethiopia, where 91% of the health workers are recapping needles after injection [ 18 ]. The research finding shows that there is no significant association P-value of 0.82 between the training and recapping of needles after injection.

Focus group participants ’ response for appropriate SHCWMP regarding patients ’ and visitors ’ lack of knowledge on SHCW segregation practice

“The personal responsibilities of patients and visitors on solid HCW disposal should be explained to help appropriate safe waste management practice and maintain good hygiene .” “Providing waste management training and creating awareness are the two aspects of improving SHCW segregation practice.” “Training upgrades and creates awareness on hygiene for all workers.”

Sharp waste collection practices were observed in 240 rooms in the study health facilities, and 9.2% of the rooms used disposable sharp containers.

Sixty per cent (60%), 13.3%, 8.24%, and 15.71% of the sharps containers in NEMMCSH, government health centres, medium clinics, and small clinics, respectively, were using disposable sharps containers; sharps were disposed together with the sharps container, and surgical centre was using reusable sharp collection container. All disposable sharps containers in medium and small clinics used non-puncture-resistant or simple packaging carton boxes. 60% and 13.3% of the disposable sharps containers in NEMMCSH and the government health centre use purposefully manufactured disposable safety boxes.

Needle sticks injury reporting and occurrence

A total of 70 injuries were reported to the health facility manager in the last one year, and 44 of the injuries were reported by health professionals. The rest of the injuries were reported by supportive staff. These injuries were reported from 35 health facilities, and the remaining six health facilities did not report any cases of injury related to work; see Tables 2 and 3 below.

Accidents or incidents, including near misses, spillages, damaged containers, inappropriate segregation, and any incidents involving sharps, should be reported to the waste-management officer. Accidental contamination must be notified using a standard-format document. The cause of the accident or incident should be investigated by the waste-management officer (in case of waste) or another responsible officer, who should also take action to prevent a recurrence [ 13 ]. Two hundred seventy-one (50.2% (CI: 45.7–54.6) of the respondents agree that satisfactory procedures are available in case of an accident, while the remaining 269 (49.8%( CI: 45.4–54.3) of respondents do not agree on the availability of satisfactory procedures in case of an accident, see Table  4 below. The availability of satisfactory procedures in case of an accident is above the mean in medium clinics, which is 60.8%. 132(24.4%) of the staff are pricked by needle stick injury while providing health services. Nearly half of the respondents, 269 (49.8%), who have been exposed to needle stick injury do not get satisfactory procedures after being pricked by a needle, and those who have not been stung by a needle stick injury for the last year. 204 (37.8%) disagree with the presence of satisfactory procedures in the case of a needle stick injury. In NEMMCSH, 30.2% of the research participants were pricked by needle stick injury within one year of period, and 48.8% of those who were stung by needle stick injuries did not agree upon the presence of satisfactory procedures in case of needle stick injuries in the study hospital. 17.9% and 49.5%, 24.1% and 60.8%, 7.6% and 50% of the respondents are pricked by needle sticks, and they disagree on the availability of satisfactory procedures in case of accidents, respectively, in government health centres, medium clinics, small clinics, and surgical centre respectively.

One hundred seventy-seven (32.7% (CI:29.1–37) respondents were exposed to needle stick injury while working in the current health facilities. One hundred three (58.1%) and 26 (32.9%) needle stick injuries were reported from WUNEMMCSH and medium clinics, which is above the mean. One hundred thirty-two(24.7% (95%CI:20.7–28.1) of the respondents are exposed to needle stick injury within one year of the period. Seventy-eight(30.2%), 17 (17.9%), 19 (24.1%), 15 (16.3%), 3 (18.8%) of the staff are injured by needle sticks from NEMMCSH, government health centres, medium clinics, small clinics, and surgical centre staffs respectively within one year of service.

The mean availabilities of satisfactory procedures in case of accidents were 321 (59.4% (CI:55.4–63.7). Out of this, 13.7% of the staff is injured by needle sticks within one year before the survey. Except in NEMMCSH, the mean availabilities of satisfactory procedures were above the mean, which is 50%, 60%, 77.2%, 66.3%, and 81.3% in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively.

Table 5 below shows that Hepatitis B, COVID-19, and tetanus toxoid vaccinations are the responses of the research participants to an open-ended question on which vaccine they took. The finding shows that 220 (40.8%) of the respondents were vaccinated to prevent themselves from health facility-acquired infection. One hundred fifty-six (70.9%) of the respondents are vaccinated to avoid themselves from Hep B infection. Fifty-nine (26%0.8) of the respondents were vaccinated to protect themselves from two diseases that are Hep B and COVID-19.

Appropriate health care waste management practice was assessed by using 12 questions: availability of colour-coded waste bins, foot-operated dust bins, elbow or foot-operated hand washing basin, personal protective equipment, training, role and responsibility of the worker, the presence of satisfactory procedures in case of an accident, incinerator, vaccination, guideline, onsite treatment, and the availability of poster. The mean of appropriate healthcare waste management practice was 55.58%. The mean of solid health care waste management practice based on the level of health facilities was summed and divided into 12 variables to get each health facility’s level of waste management practice. 64.9%, 45.58%, 49%, 46.9%, and 51.8% are the mean appropriate health care waste management practices in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres, respectively. In NEMMCSH, the practice of solid healthcare waste management shows above the mean, and the rest was below the mean of solid healthcare waste management practice.

Healthcare waste treatment and disposal practice

Solid waste treatment before disposal was not practised at all study health facilities. There is an incineration practice at all of the study health facilities, and the World Health Organization 2014 recommended three types of incineration practice for solid health care waste management: dual-chamber starved-air incinerators, multiple chamber incinerators, and rotary kilns incinerators. Single-chamber, drum, and brick incinerators do not meet the best available technique requirements of the Stockholm Convention guidelines [ 13 ]. The findings of this study show that none of the incinerators found in the study health facilities meet the minimum standards of solid healthcare waste incineration practice, and they need an air inlet to facilitate combustion. Eleven (26.82%) of the health facilities have an ash pit to dispose of burned SHCW; the majority, 30 (73.17%), dispose of the incinerated ash and burned needles in the municipal waste disposal site. In one out of 11 health facilities with an ash pit, one of the incinerators was built on the ash pit, and the incinerated ashes were disposed of in the ash pit directly. Pre-treatment of SHCW before disposal was not practised at all health facilities; see Table  6 below.

All government health facilities use incineration to dispose of solid waste. 88.4% and 100% of the solid wastes are incinerated in WUNEMMCS Hospital and government health centres, respectively. This finding was not similar to the other studies because other technologies like autoclave microwave and incineration were used for 59–60% of the waste [ 15 ]. Forty-one (100%) of the study facilities were using incinerators, and only 5 (12.19%) of the incinerators were constructed by using brick and more or less promising than others for incinerating the generated solid wastes without considering the emitting gases into the atmosphere and the residue chemicals and minerals in the ashes.

Research participants’ understanding of the environmental friendliness of health care waste management practice was assessed, and the result shows that more than half, 312(57%) of the research participants do not agree on the environmental friendliness of the waste disposal practices in the health facilities. The most disagreement regarding environmental friendliness was observed in NEMMCSH; 100 (38.8%) of the participants only agreed the practice was environmentally friendly of the service. Forty-four (46.3%), 37 (46.8%), 40 (43.5%), and 7 (43.8%) of the participants agree on the environmental friendliness of healthcare waste management practice in government health centres, medium clinics, small clinics, and surgical centres, respectively.

One hundred twenty-five (48.4%) and 39(42.4%) staff are trained in solid health care waste management practice in NEMMCSH and small clinic staff, respectively; this result shows above the mean. Twenty-seven (28.4%), 30 (38%), and 4 (25%) of the staff are trained in health care waste management practice in Government health centres, medium clinics, and surgical centres, respectively. The training has been significantly associated with needle stick injury, and the more trained staff are, the less exposed to needle stick injury. One hundred ninety-six (36.4%) of the participants answered yes to the question about the availability of trainers in the institution. 43.8% of the NEMMCSH staff agreed on the availability of trainers on solid health care waste management, which is above the mean, and 26.3%, 31.6%, 31.5%, and 25% for the government health centres, medium clinics, small clinics, and surgical centre respectively, which is below the mean.

Trained health professionals are more compliant with SHCWM standards, and the self-reported study findings of this study show that 41.7% (95%CI:37.7–46) of the research participants are trained in health care waste management practice. This finding was higher compared to the study findings of Sahiledengle in 2019 in the southeast of Ethiopia, shows 13.0% of healthcare workers received training related to HCWM in the past one year preceding the study period and significantly lower when compared to the study findings in Egypt which is 71% of the study participants were trained on SHCWM [ 8 , 19 , 20 ].

Three out of four government health facility leaders, 17 (45.94%) of private health facility leaders/owners of the clinic and 141 FGD participants complain about the absence of some PPEs like boots and aprons to protect themselves from infectious agents.

‘ ‘Masks, disposable gloves, and changing gowns are a critical shortage at all health facilities.’’

Cleaners in private health facilities are more exposed to infectious agents because of the absence of personal protective equipment. Except for the cleaning staff working in the private surgical centre, all cleaning staff 40 (97.56) of the health facilities complain about the absence of changing gowns and the fact that there are no boots in the facilities.

Cost inflation and the high cost of purchasing PPEs like gloves and boots are complained by all of (41) the health facility owners and the reason for the absence of some of the PPEs like boots, goggles, and shortage of disposable gloves. Sometimes, absence from the market is the reason why we do not supply PPE to our workers.

Thirty-four (82.92%) of the facility leaders are forwarded, and there is a high expense and even unavailability of some of the PPEs, which are the reasons for not providing PPEs for the workers.

‘‘Medical equipment and consumables importers and whole sellers are selective for importing health supplies, and because of a small number of importers in the country and specifically, in the locality, we can’t get materials used for health care waste management practice even disposable gloves. ’’

One of the facility leaders from a private clinic forwarded that before the advent of COVID-19 -19) personal protective equipment was more or less chip-and-get without difficulty. Still, after the advent of the first Japanese COVID-19 patient in Ethiopia, people outside the health facilities collect PPEs like gloves and masks and storing privately in their homes.

‘‘PPEs were getting expensive and unavailable in the market. Incinerator construction materials cost inflation, and the ownership of the facility building are other problems for private health facilities to construct standard incinerators.’’

For all of the focus group discussion participants except in NEMMCSH and two private health facilities, covered and foot-operated dust bins were absent or in a critical shortage compared to the needed ones.

‘‘ Waste bins are open and not colour-coded. The practice attracts flies and other insects. Empty waste bins are replaced without cleaning and disinfecting by using chlorine solution.’’ “HCW containers are not colour-coded, but we are trying to label infectious and non-infectious in Amharic languages.”

Another issue raised during focus group discussions is incineration is not the final disposal method. It needs additional disposal sites, lacks technology, is costly to construct a brick incinerator, lacks knowledge for health facility workers, shortage of man powers /cleaners, absence of environmental health professionals in health centres and all private clinics, and continues exposure to the staff for needle stick injury, foully smell, human scavengers, unsightly, fire hazard, and lack of water supply in the town are the major teams that FGD participants raise and forwarded the above issue as a problem to improve SHCWMP.

Focus group participants, during the discussion, raised issues that could be more comfortable managing SHCWs properly in their institution. Two of the 37 private health facilities are working in their own compound, and the remaining 35 are rented; because of this, they have difficulty constructing incinerators and ash removal pits and are not confident about investing in SHCWM systems. Staff negligence and involuntary abiding by the rules of the facilities were raised by four of the government health facilities, and it was difficult to punish those who violated the healthcare waste management rules because the health facility leaders were not giving appropriate attention to the problem.

Focus group participants forwarded recommendations on which interventions can improve the management of SHCW, and recommendations are summarised as follows:

“PPE should be available in quality and quantity for all health facility workers who have direct contact with SHCW.” “Scientific-based waste management technologies should be availed for health facilities.” “Continuous induction HCW management training should be provided to the workers. Law enforcement should be strengthened.” “Communal HCW management sites should be availed, especially for private health facilities.” “HCWM committee should be strengthened.” “Non-infectious wastes should be collected communally and transported to the municipal SHCW disposal places.” “Leaders should be knowledgeable on the SHCWM system and supervise the practice continuously.” “Patient and client should be oriented daily about HCW segregation practice.” “Regulatory bodies should supervise the health facilities before commencing and periodically between services .”

The above are the themes that FGD participants discussed and forwarded for the future improvements of SHAWMP in the study areas.

Lack of water supply in the town

Other issues raised during FGDs were health facilities’ lack of water supply. World Health Organization (2014: 89) highlights that water supply for the appropriate waste management system should be mandatory at any time in all health service delivery points.

Thirty-nine (95.12%) of the health facilities complain about the absence of water supply to improve HCW management practices and infection prevention and control practices in the facilities.

“We get water once per week, and most of the time, the water is available at night, and if we are not fetching as scheduled, we can’t get water the whole week”.

In this research, only those who have direct contact have participated in this study, and 434 (80.4%) of the respondents agree they have roles and responsibilities for appropriate solid health care waste management practice. The rest, 19.6%, do not agree with their commitment to manage health care wastes properly, even though they are responsible. Health facility workers in NEMMCSH and medium clinics know their responsibilities better than others, and their results show above the mean. 84.5%, 74.5%, 81%, 73.9% and 75% in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centres, respectively.

Establishing a policy and a legal framework, training personnel, and raising public awareness are essential elements of successful healthcare waste management. A policy can be viewed as a blueprint that drives decision-making at a political level and should mobilize government effort and resources to create the conditions to make changes in healthcare facilities. Three hundred and seventy-four (69.3%) of the respondents agree with the presence of any solid healthcare waste management policy in Ethiopia. The more knowledge above the mean (72.9%) on the presence of the policy is reported from NEMMCSH.

Self-reported level of knowledge on what to do in case of an accident revealed that 438 (81.1% CI: 77.6–84.3%) of the respondents knew what to do in case of an accident. Government health centre staff and medium clinic staff’s knowledge about what to do in case of an accident was above the mean (88.4% and 82.3%), respectively, and the rest were below the mean. The action performed after an occupational accident revealed that 56 (35.7%) of the respondents did nothing after any exposure to an accident. Out of 56 respondents who have done nothing after exposure, 47 (83.92%) of the respondents answered yes to their knowledge about what to do in case of an accident. Out of 157 respondents who have been exposed to occupational accidents, only 59 (37.6%) of the respondents performed the appropriate measures, 18 (11.5%), 9 (5.7%), 26 (16.6%), 6 (3.8%) of the respondents are taking prophylaxis, linked to the incident officer, consult the available doctors near to the department, and test the status of the patient (source of infection) respectively and the rest were not performing the scientific measures, that is only practising one of the following practices washing the affected part, squeezing the affected part to remove blood, cleaning the affected part with alcohol.

Health facility workers’ understanding of solid health care waste management practices was assessed by asking whether the current SHCWM practice needs improvement. Four hundred forty-nine (83.1%) health facility workers are unsatisfied with the current solid waste management practice at the different health facility levels, and they recommend changing it to a scientific one. 82.6%, 87.4%, 89.9%, 75%, and 81.3% of the respondents are uncomfortable or need to improve solid health care waste management practices in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres, respectively.

Lack of safety box, lack of colour-coded waste bins, lack of training, and no problems are the responses to the question problems encountered in managing SHCWMP. Two Hundred and Fifty (46.92%) and 232 (42.96%) of the respondents recommend the availability of safety boxes and training, respectively.

Four or 9.8% of the facilities have infection prevention and control (IPC) teams in the study health facilities. This finding differed from the study in Pakistan, where thirty per cent (30%) of the study hospitals had HCWM or infection control teams [ 21 ]. This study’s findings were similar to those conducted in Pakistan by Khan et al. [ 21 ], which confirmed that the teams were almost absent at the secondary and primary healthcare levels [ 20 ].

The availability of health care waste management policy report reveals that 69.3% (95% CI: 65.4–73) of the staff are aware of the presence of solid health care waste management policy in the institution. Availability of health care waste management policy was 188 (72.9%), 66 (69.5%), 53 (677.1%), 57 (62%), 10 (62.5%) in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centre respectively. Healthcare waste management policy availability was above the mean in NEMMCSH and government health centres; see Table  6 below.

Open-ended responses on the SHCWM practice of health facility workers were collected using the prepared interview guide, and the responses were analyzed using thematic analysis. All the answered questions were tallied on the paper and exported to Excel software for thematic analysis.

The study participants recommend.

“appropriate segregation practice at the point of generation” "health facility must avail all the necessary supplies that used for SHCWMP, punishment for those violating the rule of SHCWMP",

“waste management technologies should be included in solid waste management guidelines, and enforcement should be strengthened.”

The availability of written national or adopted/adapted SHCWM policies was observed at all study health facilities. Twenty eight (11.66%) of the rooms have either a poster or a written document of the national policy document. However, all staff working in the observed rooms have yet to see the inside content of the policy. The presence of the policy alone cannot bring change to SHCWMP. This finding shows that the presence of policy in the institution was reasonable compared to the study findings in Menelik II hospital in Addis Ababa, showing that HCWM regulations and any applicable facility-based policy and strategy were not found [ 22 ]. The findings of this study were less compared to the study findings in Pakistan; 41% of the health facilities had the policy document or internal rules for the HCWM [ 21 ].

Focus group participants have forwarded recommendations on which interventions can improve the management of SHCW, and recommendations are summarised as follows.

‘‘Supplies should be available in quality and quantity for all health facility workers with direct contact with SHCW. Scientific-based waste management technologies should be available for health facilities. Continues and induction health care waste management training should be provided to the workers. Law enforcement should be strengthened. Community healthcare waste management sites should be available, especially for private health facilities. HCWM committee should be strengthened. Non-infectious wastes should be collected communally and transported to the municipal SHCW disposal places. Leaders should be knowledgeable about the SHCWM system and supervise the practice continuously. Patients and clients should be oriented daily about health care waste segregation practices. Regulatory bodies should supervise the health facilities before commencing and periodically in between the service are the themes those FGD participants discussed and forward for the future improvements of SHCWMP in the study areas.’’

The availability of PPEs in different levels of health facilities shows 392 (72.6%), 212 (82.2%), 56 (58.9%), 52 (65.8%), 60 (65.2%), 12 (75%) health facility workers in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively agree to the presence of personal protective equipment in their department. The availability of PPEs in this study was nearly two-fold when compared to the study findings in Myanmar, where 37.6% of the staff have PPEs [ 12 ].

The mean availability of masks, heavy-duty gloves, boots, and aprons was 71.1%, 65.4%, 38%, and 44.4% in the study health facilities. This finding shows masks are less available in the study health facilities compared to other studies. The availability of utility gloves, boots, and plastic aprons is good in this study compared to the study conducted by Banstola, D in Pokhara Sub-Metropolitan City [ 23 ].

The findings of this study show there is a poor segregation practice, and all kinds of solid wastes were collected together. This finding was similar to the study findings conducted in Addis Ababa, Ethiopia, by Debere et al. [ 24 ] and contrary to the study findings conducted in Nepal and India, which shows 50% and 65–75% of the surveyed health facilities were practising proper waste segregation systems at the point of generation without mixing general wastes with hazardous wastes respectively [ 9 , 17 ].

Ninety percent of private health facilities collect and transport SHCW generated in every service area and transport it to the disposal place by the collection container (no separate container to collect and transport the waste to the final disposal site). This finding was similar to the study findings of Debre Markos’s town [ 25 ]. At all of the facilities in the study area, SHCW was transported from the service areas to the disposal site manually by carrying the collection container, and there was no trolley for transportation. This finding was contrary to the study findings conducted in India, which show segregated waste from the generation site was being transported through the chute to the carts placed at various points on the hospital premises by skilled sanitary workers [ 17 ].

Observational findings revealed that pre-treatment of SHCW before disposal was not practised at all study health facilities. This study was contrary to the findings of Pullishery et al. [ 26 ], conducted in Mangalore, India, which depicted pre-treatment of the waste in 46% of the hospitals [ 26 ]. 95% of the facilities have no water supply for handwashing during and after solid healthcare waste generation, collection, and disposal. This finding was contrary to the study findings in Pakistan hospitals, which show all health facilities have an adequate water supply near the health care waste management sites [ 27 ].

Questionnaire data collection tools show that 129 (23.8%) of the staff needle stick injuries have occurred on health facility workers within one year of the period before the data collection. This finding was slightly smaller than the study findings of Deress et al. [ 25 ] in Debre Markos town, North East Ethiopia, where 30.9% of the workers had been exposed to needle stick injury one year prior to the study [ 25 ]. Reported and registered needle stick injuries in health facilities are less reported, and only 70 (54.2%) of the injuries are reported to the health facilities. This finding shows an underestimation of the risk and the problem, which was supported by the study conducted in Menilik II hospitals in Addis Ababa [ 22 ]. 50%, 33.4%, 48%, 52%, and 62.5% of needle stick injuries were not reported in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centres, respectively, to the health facility manager.

Nearly 1/3 (177 or 32.7%) of the staff are exposed to needle stick injuries. Needle stick injuries in health facilities are less reported, and only 73 (41.24%) of the injuries are reported to the health facilities within 12 months of the data collection. This finding is slightly higher than the study finding of Deress et al. [ 25 ] in Debere Markos, Ethiopia, in which 23.3% of the study participants had encountered needle stick/sharps injuries preceding 12 months of the data collection period [ 25 ].

Seventy-three injuries were reported to the health facility manager in the last one year, 44 of the injuries were reported by health professionals, and the rest were reported by supportive staff. These injuries were reported from 35(85.3%) health facilities; the remaining six have no report. These study findings were better than the findings of Khan et al. [ 21 ], in which one-third of the facilities had a reporting system for an incident, and almost the same percentage of the facilities had post-exposure procedures in both public and private sectors [ 21 ].

Within one year of the study period, 129 (23.88%) needle stick injuries occurred. However, needle stick injuries in health facilities are less reported, and only 70 (39.5%) of the injuries are reported to the health facilities. These findings were reasonable compared to the study findings of the southwest region of Cameroon, in which 50.9% (110/216) of all participants had at least one occupational exposure [ 28 , 29 ]. This result report shows a very high exposure to needle stick injury compared to the study findings in Brazil, which shows 6.1% of the research participants were injured [ 27 ].

The finding shows that 220 (40.8%) of the respondents were vaccinated to prevent themselves from health facility-acquired infection. One Hundred Fifty-six (70.9%) of the respondents are vaccinated in order to avoid themselves from Hep B infection. Fifty-nine (26%0.8) of the respondents were vaccinated to protect themselves from two diseases that are Hep B and COVID-19. This finding was nearly the same as the study findings of Deress et al. [ 7 ],in Ethiopia, 30.7% were vaccinated, and very low compared to the study findings of Qadir et al. [ 30 ] in Pakistan and Saha & Bhattacharjya India which is 66.67% and 66.17% respectively [ 25 , 30 , 31 ].

The incineration of solid healthcare waste technology has been accepted and adopted as an effective method in Ethiopia. These pollutants may have undesirable environmental impacts on human and animal health, such as liver failure and cancer [ 15 , 16 ]. All government health facilities use incineration to dispose of solid waste. 88.4% and 100% of the wastes are incinerated in WUNEMMCSH and government health centres, respectively. This finding contradicts the study findings in the United States of America and Malaysia, which are 49–60% and 59–60 are incinerated, respectively, and the rest are treated using other technologies [ 15 , 16 ].

All study health facilities used a brick or barrel type of incinerator. The incinerators found in the study health facilities need to meet the minimum standards of solid health care waste incineration practice. These findings were similar to the study findings of Nepal and Pakistan [ 32 ]. The health care waste treatment system in health facilities was found to be very unsystematic and unscientific, which cannot guarantee that there is no risk to the environment and public health, as well as safety for personnel involved in health care waste treatment. Most incinerators are not properly operated and maintained, resulting in poor performance.

All government health facilities use incineration to dispose of solid waste. All the generated sharp wastes are incinerated using brick or barrel incinerators, as shown in Fig.  1 above. This finding was consistent with the findings of Veilla and Samwel [ 33 ], who depicted that sharp waste generation is the same as sharps waste incinerated [ 33 ]. All brick incinerators were constructed without appropriate air inlets to facilitate combustion except in NEMMCSH, which is built at a 4-m height. These findings were similar to the findings of Tadese and Kumie at Addis Ababa [ 34 ].

Barrel and brick incinerators used in private clinic

Strengths and limitations

This is a mixed-method study; both qualitative and quantitative study design, data collection and analysis techniques were used to understand the problem better. The setting for this study was one town, which is found in the southern part of the country. It only represents some of the country’s health facilities, and it is difficult to generalize the findings to other hospitals and health centres. Another limitation of this study was that private drug stores and private pharmacies were not incorporated.

Conclusions

In the study, health facilities’ foot-operated solid waste dust bins are not available for healthcare workers and patients to dispose of the generated wastes. Health facility managers in government and private health institutions should pay more attention to the availability of colour-coded dust bins. Most containers are opened, and insects and rodents can access them anytime. Some of them are even closed (not foot-operated), leading to contamination of hands when trying to open them.

Healthcare waste management training is mandatory for appropriate healthcare waste disposal. Healthcare-associated exposure should be appropriately managed, and infection prevention and control training should be provided to all staff working in the health facilities.

Availability of data and materials

The authors declare that data for this work are available upon request to the first author.

Chartier, Y et al. Safe management of wastes from health-care activities. 2nd ed. WHO; 2014.

Tesfahun E, et al. Developing models for the prediction of hospital healthcare waste generation rate. Waste Manag Res. 2014;34(1):75–80.

Manzoor J, Sharma M. Impact of Biomedical Waste on Environment and Human Health. Environmental Claims Journal. 2019;31(4):311–34.

Article   Google Scholar  

Yves C, Jorge E, Ute P, Annette P, et al. Safe management of wastes from health-care activities. WHO 2nd ed. 2014.

OSHA. Occupational Safety and Health Administration, Guidelines for Healthcare Waste Management. 2023.

Godfrey L, Ahmed M, et al. Solid waste management in Africa: governance failure or development opportunity?. Intech open. 2019.

Deress T, Jemal M, Girma M, Adane K. Knowledge, attitude, and practice of waste handlers about medical waste management in Debre Markos town healthcare facilities, northwest Ethiopia. BMC Res Notes. 2019;12(1):146.

Article   PubMed   PubMed Central   Google Scholar  

Sahiledengle B. Self-reported healthcare waste segregation practice and its correlate among healthcare workers in hospitals of Southeast Ethiopia. BMC Health Serv Res. 2019;19(1):591.

Debalkie D, Kume A. Healthcare Waste Management: The Current Issue in Menellik II Referral Hospital, Ethiopia. Curr World Environ. 2017;12(1):42–52.

Debere MK, Gelaye KA, Alamdo AG, Trifa ZM. Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011. BMC Public Health. 2013;13(28).

Creswell JW. Research design qualitative, quantitative, & mixed method approach. 4th ed. SAGE Publications, Inc.; 2014.

Win EM, Saw YM, Oo KL, Than TM, Cho SM, Kariya T, et al. Healthcare waste management at primary health centres in Mon State, Myanmar: the comparisons between hospital and non-hospital type primary health centres. Nagoya J Med Sci. 2019;81(1):81–91.

PubMed   PubMed Central   Google Scholar  

WHO. Safe management of wastes from health-care activities. 2nd ed. editor Chartier, Y et al. 2014. 

Richard B, Ben A, Kristian S. Health care without harm climate-smart health care series green paper number one. 2019.

Khadem Ghasemi M, Mohd YR. Advantages and Disadvantages of Healthcare Waste Treatment and Disposal Alternatives: Malaysian Scenario. Pol J Environ Stud. 2016;25(1):17–25.

Mohseni-Bandpei A, Majlesi M, Rafiee M, Nojavan S, Nowrouz P, Zolfagharpour H. Polycyclic aromatic hydrocarbons (PAHs) formation during the fast pyrolysis of hazardous health-care waste. Chemosphere. 2019;227:277–88.

Article   PubMed   CAS   Google Scholar  

Pandey A, Ahuja S, Madan M, Asthana AK. Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview. J Clin Diagn Res. 2016;10(11):DC01-DC3.

Doylo T, Alemayehu T, Baraki N. Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern Ethiopia. J Community Health. 2019;44(2):284–91.

Article   PubMed   Google Scholar  

Hosny G, Samir S, Sharkawy R. An intervention significantly improve medical waste handling and management: A consequence of raising knowledge and practical skills of health care workers. Int J Health Sci.2018;12(4).

Khan EA, Sabeeh SM, Chaudhry MA, Yaqoob A, Kumar R. et al. Health care waste management in Pakistan: A situational analisis and way forward. Pak J Public Health. 2016;6(3).

Khan BA, Cheng L, Khan AA, Ahmed H. Healthcare waste management in Asian developing countries: A mini review. Waste Manag Res. 2019;37(9):863–75.

Debalkie D, Kumie A. Healthcare Waste Management: The Current Issue in Menellik II Referral Hospital. Ethiopia Current World Environment. 2017;12(1):42–52.

Banstola D, Banstola R, Nepal D, Baral P. Management of hospital solid wastes: A study in Pokhara sub metropolitan city. J Institute Med. 2017;31(1):68–74.

Debere MK, Gelaye KA, Alamdo AG, Trifa, ZM. Assessment of the HCW generation rates and its management system in hospitals of Addis Ababa, Ethiopia. BMC Public Health. 2014;13(28):1–9.

Deress T, Hassen F, Adane K, Tsegaye A. Assessment of Knowledge, Attitude, and Practice about Biomedical Waste Management and Associated Factors among the Healthcare Professionals at Debre Markos Town Healthcare Facilities. Northwest Ethiopia J Environ Public Health. 2018;2018:7672981.

PubMed   Google Scholar  

Pullishery F, Panchmal GS, Siddique S, Abraham A. Awareness, knowledge, and practices on bio-medical waste management among health care professionals in Mangalore- A cross sectional study. Integr Med. 2016;3(1):29–35.

Google Scholar  

Ream PS, Tipple AF, Salgado TA, Souza AC, Souza SM, Galdino-Junior H, et al. Hospital housekeepers: Victims of ineffective hospital waste management. Arch Environ Occup Health. 2016;71(5):273–80.

Ngwa CH, Ngoh EA, Cumber SN. Assessment of the knowledge, attitude and practice of health care workers in Fako division on post exposure prophylaxis to blood borne viruses: a hospital based cross-sectional study. Pan Afr Med J. 2018;31.

Health care waste managemnt in pakistan. a situation analysis and way forward. Pakistan Journal of Public Health. 2016;6(3):35–45.

Qadir DM, Murad DR, Faraz DN. Hospital Waste Management; Tertiary Care Hospitals. The Professional Medical Journal. 2016;23(07):802–6.

Saha A, Bhattacharjya H. Health-Care Waste Management in Public Sector of Tripura, North-East India: An Observational Study. Indian J Community Med. 2019;44(4):368–72.

Pullishery F, Panchmal G, Siddique S, Abraham A. Awareness, knowledge, and practices on bio-medical waste management among health care professionals in Mangalore- A cross sectional study. Integr Med. 2016;3(1):29–35.

Veilla EM, Samwel VM. Assessment of sharps waste management practices in a referral hospital. Afr J Environ Sci Technol. 2016;10(3):86–95.

Tadesse ML, Kumie A. Healthcare waste generation and management practice in government health centers of Addis Ababa. Ethiopia BMC Public Health. 2014;14:1221.

Download references

Acknowledgements

The authors are grateful to the health facility leaders and ethical committees of the hospitals for their permission. The authors acknowledge the cooperation of the health facility workers who participated in this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and affiliations.

Wachemo University College of Medicine and public health, Hossana, Ethiopia

Yeshanew Ayele Tiruneh

Department of Public Health, University of South Africa, College of Human Science, Pretoria, South Africa

L. M. Modiba & S. M. Zuma

You can also search for this author in PubMed   Google Scholar

Contributions

Dr. Yeshanew Ayele Tiruneh is a researcher of this study; the principal investigator does all the proposal preparation, methodology, data collection, result and discussion, and manuscript writing. Professor LM Modiba and Dr. SM Zuma are supervisors for this study. They participated in the topic selection and modification to the final manuscript preparation by commenting on and correcting the study. Finally, the three authors read and approved the final version of the manuscript and agreed to submit the manuscript for publication.

Corresponding author

Correspondence to Yeshanew Ayele Tiruneh .

Ethics declarations

Ethics approval and consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reprints and permissions

About this article

Cite this article.

Tiruneh, Y.A., Modiba, L.M. & Zuma, S.M. Solid health care waste management practice in Ethiopia, a convergent mixed method study. BMC Health Serv Res 24 , 985 (2024). https://doi.org/10.1186/s12913-024-11444-8

Download citation

Received : 05 March 2023

Accepted : 14 August 2024

Published : 26 August 2024

DOI : https://doi.org/10.1186/s12913-024-11444-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Health care waste
• Waste management
• Private health facilities

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]