Occupational Health Hazards and Health outcomes among health workers, the determinants and compliance to safety standards in the health facilities in Kigali City, Rwanda

Abstract

Health facility is among the workplace that contain most hazardous wastes which demands strict compliance to occupational safety and health standards. Occupational exposure to health risks is very common especially with regards to health threats from emerging diseases and health issues, this is further worsened by poor economy and hazards mitigation strategies in health facilities, work overload, growing disease burden and lack of job motivation. The current study was carried out in districts health facilities (Kibagabaga in Gasabo District, Muhima in Nyarugenge District and Masaka in Kicukiro District) in Kigali City, Rwanda. The study adopted a cross sectional design involving both qualitative and quantitative data collection approaches. The study was carried out in Kigali from July 2016 to December 2016, among the health care workers in the three District health facilities in Kigali. The objective was to assess the determinants of occupational hazards and health outcomes, waste management practices and compliance to safety measures in the three hospitals. From the study population of total of 631 consisting of various cadres of health workers, 249 participants were selected using systematic sampling technique, adopting probability proportional to size approach in allocating sample units per cadre. While simple random sampling technique was used to select the study participants for the study. Data were collected using semi structured questionnaire and interview / focus group guides. In addition, an observational checklist was used and policy documents for safety in the workplace were reviewed and to identify gap in the compliance and enforcement. Validity and Reliability of the study instrument ensured through pretesting and adjustment of data collection tool. A final reliability test scale of 7.2 was achieved. Data was analysed using simple proportion percentages, confidence interval and chi-square test of association between study variables statistically significant at 0.05 and lastly multinomial regression analysis was carried out. Study findings: The most prevalent proportion of occupational hazards cases was highest result: working accidents which account to 133 (56.1%, 95% C.I. = 49.55 – 62.54), Next is Slips and falls about 82 (34.6%, 95% C.I. = 28.56 – 41.03) and Injury with Blood borne pathogen about 78 (32.9%, 95% C.I. =26.97 – 39.29). Three variables was identified as influencing variables to hazards cases through multinomial regression analysis; the respondents’ professional categories (medical group) with (p- value = 0.016 < 0.05), Poor safety measures with (p- value = 0.022 < 0.05) and Poor hospital hazards Elimination and control measures with (p- value = 0.002 < 0.05). The most prevalent proportion of occupational hazards health outcomes are Backache 142 (60%, 95% C.I. = 53.37 – 66.21) and Lung Disease 50 (21.1%, 95% C.I. = 16.08 – 26.85) respectively. About four variables influences hazards health outcomes cases through multinomial regression analysis in the study; hospital safety compliance responsibility (p –value 0.004>0.05), pre and post exposure safety practices (p –value 0.015>0.05) and workers participation in hospital safety program (p –value 0.043>0.05), Factors that are associated with Human level occupational hazards and health outcomes determinant factors in multinomial regression analysis showed: institutional associated factors with (p- value = 0.00 < 0.05), Safety measures opinion among health care workers with (p- value = 0.00 < 0.05), Practices of post exposure safety compliance with (p- value = 0.047 < 0.05) and Masaka health facility with (p- value = 0.005 < 0.05).Furthermore, institution factors were influenced by; Hospital safety policy compliance (p- value = 0.05< 0.05), Safety practices with (p- value = 0.01 < 0.05),Workers participation in safety programs (p- value = 0.005 < 0.05) and Human level factors (p- value = 0.000 < 0.05 through multinomial regression analysis. The health facility waste management practices are influenced according to the multinomial regression analysis by; hospital policy compliance responsibility commitment (p- value = .001 < 0.05) and Human related factors (p- value = .045 < 0.05), Institution problems (p- value = 0.03 < 0.05) and the health facility strategies for elimination of hazards significant (p- value = .009 < 0.05). The hospital waste management program on inspection showed no evidence of medical waste reduction facility plan, developed rules on recovery and disposal of the waste. Findings from Compliance to safety regulations showed five variables on multinomial regression analysis: Actions that Influence poor policy (p- value = .004 < 0.05), Health facility waste practices (p- value = .002 < 0.05), Hospital management safety practices (p- value = .003 < 0.05), Health facility safety programs (p- value = .022 < 0.05) and workers participation in safety program (p- value = .042 < 0.05). Policy Gap Analysis showed: health facility accreditation system is adopted to improve quality of care. There were evidence of poor compliance to incident investigations; report and follow up, training gap and absence of statistical records of hazards and health outcomes. The focus group discussions are in support of most statistical findings in the study. Therefore, the government, health care workers and hospital administrators need to strongly address the gaps in policy, re-structuring and other corrective measures in occupational hazards and safety as a way forward.