Evaluation of human/afterbirth placenta waste management effectiveness and selection of the best treatment technology using AHP in Kampala health units

Abstract

Proper treatment of human/afterbirth placenta waste plays a major role in prevention of infection, disease transfer and environmental hazards. However, storage, treatment and disposal of the human placenta have remained a challenge especially in developing countries where resources are limited. In the case of Kampala, for example, the rapid growth of health units and number of babies born per day has caused an increase in the daily human placenta waste generated. The aim of this study was to assess the human/afterbirth placenta waste management effectiveness and structure in Kampala health units as well as apply a multi-criteria decision methodology to assist in the selection of the best technology for placenta waste management. Field visits and surveys were carried out at different health units to establish quantities of placenta generated, handling practices, on and off site transportation and storage facilities. The AHP technique was further applied to select an appropriate placenta waste treatment technology. In it, seven criteria formed the hierarchy structure (namely: treatment cost, reduction in volume, greenhouse emissions, water/fuel use, ease of operation, air emissions avoidance and inactivation of microbial growth) while four alternative technologies were considered (namely: incineration, autoclaving, centralized and mobile tissue digestion). The amount of human placenta waste generated in Kampala ranged from 1 - 15 kg per day per health unit. Yet none of the private health units practiced waste segregation. At the public health units, non-leak proof containers were used to store placenta waste under unrefrigerated conditions or left in an open central storage area. In all study health units, on site transportation was carried out manually and no wheeled trolleys were available. Practices of using shallow placenta pits and pit latrines still existed in seven (7) health units. The AHP process showed that the most important criteria for technology selection were air emission avoidance (40% weight) followed by ease of operation (12%). The best treatment technology was a mobile tissue digester using alkaline hydrolysis with a global weight of 4.9%. The study recommends the application of the mobile tissue digester to assure improvement in the management of human placenta waste in health units. However, experimental and pilot study work may need to be done to demonstrate this.