Infectious medical waste (IMW) and disease transmission: A critical public health challenge in Africa and the global implications - A systematic review.

BACKGROUND: Infectious Medical Waste (IMW) from both human and animal healthcare sources have the potential to transmit diseases in human populations due to its pathogenic composition. Conversely, a paucity of data regarding cause-and-effect relationships inhibits our understanding of the extent to which disease transmission occurs. In parts of Africa where the management of IMW is not prioritized, the risks to public health, along with its global implications cannot be ignored. METHODOLOGY: A systematic literature search following the PRISMA guidelines was conducted across five electronic databases including PubMed, Embase, Scopus, ProQuest and Ovid. Relevant studies were identified using keywords such as 'infectious medical waste', 'infectious diseases', 'routes of infection', 'route of transmission', 'epidemics', 'diseases', 'sub-Sahara Africa', and 'infectious waste management'. RESULTS: Overall, 6721 articles were retrieved from the search, 6634 of which were excluded due to a lack of alignment with the study objectives. After screening, 87 studies were deemed eligible and were included in the review. Our findings identified 11 diseases that are potentially transmissible via IMW. These include Anthrax, Crimean-congo haemorrhagic Fever, Ebola Virus Disease, Hepatitis B, Hepatitis C, Human Immunodeficiency Virus, Lassa Fever, Measles, Monkeypox, Plague, and Rift Valley Fever. Disease transmission may occur via human contact with different classes of IMW, contaminated materials and accessories. CONCLUSIONS: Medical waste can be a source of infectious disease transmission. However, evidence of such a pathway is currently unavailable due to a paucity of scientific data. Therefore, further research is needed to establish cause-and-effect relationships.