Medical waste disposal practices and their health consequences in resource-limited settings: a systematic review and meta-analysis

BACKGROUND: Safe healthcare waste (HCW) management is critical for environmental and public health. In resource-limited settings (RLS), expanding healthcare services have increased medical waste, but systems for safe disposal are often lacking. METHODS: A comprehensive search of studies published between January 2018 and September 2023 was conducted in PubMed, Scopus, Web of Science, EMBASE, and Global Index Medicus. Included studies were observational studies examining HCW practices and related health outcomes. Two reviewers independently screened studies, assessed quality using Joanna Briggs Institute tools, and extracted data. Meta-analyses were performed using random-effects models to calculate pooled odds ratios (ORs) and prevalence estimates, with heterogeneity quantified using I² statistics. RESULTS: Of 5,872 records, 94 studies met inclusion criteria. Inadequate waste segregation had a pooled prevalence of 68.4% (95% CI: 61.2–75.1%, I² = 96.5%). Open dumping or uncontrolled burning was the most common disposal method (57.1%, 95% CI: 48.9–65.0%). Healthcare workers in facilities with poor waste management had 4.31 times higher odds of needle-stick injuries (95% CI: 3.02–6.15) and 3.45 times higher odds of Hepatitis B infection (95% CI: 2.10–5.68) compared to controls. Limited community-level data (n = 5, exploratory) showed increased respiratory infections and diarrhea in children living near poorly managed HCW sites. CONCLUSION: This study provides comprehensive quantitative evidence that systematic failures in HCW disposal in RLS are directly associated with significant, preventable health risks. The findings underscore an urgent need for targeted interventions including capacity building, resource investment, policy enforcement, and affordable, context-specific technologies to reduce the disease burden linked to unsafe HCW management.