Perception of Midwives on Placenta Disposal in Selected Hospitals

1.0 Introduction

1.1 Background of Study

In Nigeria, the management of placenta and other medical waste has been a significant public health concern for decades. A major issue has been the inadequate infrastructure and lack of standardized waste disposal systems, which have often led to improper handling and disposal of healthcare waste, including placenta (Ogunleye et al., 2019). Historically, healthcare facilities in Nigeria, especially those in rural and semi-urban areas, have struggled with limited resources, which include poor waste disposal systems and insufficient training for healthcare workers, including midwives, on the proper handling of medical waste (Adebayo & Olatunji, 2020).

The disposal of placenta in healthcare settings is an essential yet often overlooked aspect of waste management in hospitals. In Port Harcourt Metropolis, as in many parts of Nigeria, the handling and disposal of biological waste, particularly the placenta, remains a significant challenge. The placenta, a byproduct of childbirth, contains potential health risks if improperly disposed of, including the transmission of infectious diseases. The World Health Organization has emphasized the importance of proper waste management in healthcare facilities, as failure to do so can lead to outbreaks of hospital-acquired infections (HAIs) and environmental contamination (WHO, 2018).

In Nigerian hospitals, midwives are typically the primary healthcare professionals responsible for the immediate care of mothers during childbirth, including the management of placenta disposal. The perception and practices of midwives regarding placenta disposal are crucial, as their actions directly influence the health and safety of both the mothers and the healthcare environment. Previous studies have highlighted that inadequate training, poor infrastructure, and a lack of effective policies on waste disposal often lead to improper handling of medical waste, including the placenta, in many hospitals across Nigeria (Ogunleye et al., 2019; Adebayo & Olatunji, 2020).

In Port Harcourt, which is home to a variety of healthcare institutions, there is a growing need to understand the attitudes and knowledge of midwives regarding placenta disposal. The lack of comprehensive research in this area has created a gap in understanding how midwives' perceptions influence their practices, particularly in relation to the disposal of biological waste. This is significant because improper placenta disposal poses both health and environmental risks, such as cross-contamination and the spread of infections (Okoli, 2018). Furthermore, factors such as inadequate resources, lack of awareness, and insufficient training contribute to these challenges, affecting the overall efficiency of waste management systems in healthcare facilities.

The management and disposal of biological waste, particularly placenta disposal, is a critical aspect of healthcare that directly affects both environmental health and public safety. In Port Harcourt Metropolis, as in many parts of Nigeria, proper disposal of placenta remains an under-explored issue, despite its implications for infection control and the preservation of environmental integrity (Okoli, 2018).

Midwives, being key healthcare professionals in maternal and neonatal care, play an essential role in the management and disposal of the placenta. Their perceptions of placenta disposal methods are crucial as they often influence the practices adopted in hospitals (Adebayo & Olatunji, 2020). Proper disposal techniques are critical in preventing cross-contamination and ensuring that healthcare facilities comply with standard infection control protocols. The effectiveness of these procedures, however, can vary depending on the knowledge, training, and attitudes of midwives towards placenta disposal.

In the context of Port Harcourt, a city with a growing population and numerous healthcare facilities, understanding how midwives perceive and approach placenta disposal is vital. It is necessary to assess whether there is adequate training on the environmental and health risks associated with improper placenta disposal and whether midwives are sufficiently equipped with the necessary resources and knowledge to implement proper disposal methods. Previous studies have shown that inadequate training and insufficient waste disposal systems in hospitals may contribute to improper handling of such biological waste (Ogunleye et al., 2019).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to explore the perceptions of midwives on placenta disposal in selected hospitals in Port Harcourt Metropolis.

1.2 Statement of Problems

Investigation revealed that the disposal of placenta in healthcare facilities has long been a significant challenge in many parts of the world, including Nigeria. In Port Harcourt Metropolis, where the demand for healthcare services is high and the population is rapidly growing, the improper disposal of placental waste is an issue that remains underexplored. This problem is compounded by inadequate waste management systems, limited resources, and insufficient training for healthcare workers, particularly midwives. While the proper disposal of placenta is crucial for preventing health risks such as infections and environmental contamination, evidence suggests that many midwives in Port Harcourt still engage in unsafe disposal practices due to a lack of proper knowledge, training, and standardized procedures.

Furthermore, the influence of cultural and social factors on healthcare practices has not been sufficiently investigated in this context, making it difficult to assess how these factors impact the safe disposal of placenta. While efforts have been made to improve healthcare waste management in Nigeria, the actual impact on midwives' disposal practices remains unclear. It is against the backdrop that this study seeks to address these problems by evaluating the perception of midwives on placenta disposal in selected hospitals in Port Harcourt Metropolis.

1.3 Aim and Objectives of Study

The aim of the study is to explore the perceptions of midwives regarding placenta disposal in selected hospitals within Port Harcourt Metropolis. The specific objectives of the study are:

1. To assess the level of knowledge midwives have regarding the proper disposal of placenta in selected hospitals in Port Harcourt Metropolis.
2. To evaluate the attitudes of midwives towards the disposal of placenta and the associated health risks.
3. To examine the practices of midwives in relation to placenta disposal and identify any barriers they face in adhering to proper disposal methods.
4. To explore the factors that influence the perceptions and practices of midwives in placenta disposal, including cultural, social, and institutional influences.
5. To identify the challenges faced by healthcare facilities in ensuring the proper disposal of placenta and how these challenges affect the role of midwives in maintaining safe practices.

1.4 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there factors influencing the perceptions and practices of midwives in placenta disposal, including cultural, social, and institutional factors?
• What is the level of knowledge of midwives regarding the proper disposal of placenta in selected hospitals in Port Harcourt Metropolis?
• What are the attitudes of midwives towards placenta disposal and the associated health risks in the hospitals studied?
• What are the actual practices of midwives regarding placenta disposal in selected hospitals, and what challenges do they encounter in adhering to proper disposal methods?
• What are the key challenges faced by healthcare facilities in Port Harcourt Metropolis in ensuring the proper disposal of placenta, and how do these challenges affect midwives' roles in maintaining safe disposal practices?

1.5 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant relationship between the level of knowledge of midwives and their attitudes toward proper placenta disposal in selected hospitals in Port Harcourt Metropolis.
• H1: There is a significant relationship between the level of knowledge of midwives and their attitudes toward proper placenta disposal in selected hospitals in Port Harcourt Metropolis.

Hypothesis Two

• H0: Midwives' practices regarding placenta disposal are not significantly influenced by institutional and cultural factors in the selected hospitals in Port Harcourt Metropolis.
• H1: Midwives' practices regarding placenta disposal are significantly influenced by institutional and cultural factors in the selected hospitals in Port Harcourt Metropolis.

1.6 Significance of Study

The findings of this study will be significant for several key stakeholders involved in maternal healthcare and waste management.

1. For midwives, the study will provide valuable insights into the challenges they face and the gaps in knowledge or training regarding placenta disposal, leading to improved practices and professional development opportunities.
2. For hospital administrators, the study will highlight the need for better policies, infrastructure, and training programs that ensure the proper disposal of placenta, fostering a safer working environment and compliance with health regulations.
3. Public health officials will benefit from the study as it will offer data to guide the formulation of health policies and waste management strategies that prioritize safe disposal methods, thus reducing health risks associated with improper practices.
4. For patients, particularly pregnant women, the study will emphasize the importance of safe placenta disposal, contributing to overall health and well-being by ensuring a hygienic and supportive hospital environment.
5. Finally, researchers and academics will gain a clearer understanding of the relationship between midwives' perceptions and placenta disposal practices, providing a foundation for future studies and interventions to improve healthcare waste management.

1.7 Scope of Study

The scope of this research is focused on the perception of midwives regarding placenta disposal within selected hospitals in Port Harcourt Metropolis, Rivers State, Nigeria. The study will specifically target midwives working in both public and private healthcare institutions in the metropolis, including prominent hospitals such as the University of Port Harcourt Teaching Hospital (UPTH), the Rivers State University Teaching Hospital, and other private healthcare providers.

1.8 Limitations of the Study

During the course of this study, the limitations of this study were mainly related to the scope of data collection and the sample size.

1. First, the study was limited to midwives working in selected hospitals within Port Harcourt Metropolis, which may not fully represent the perceptions of midwives in other regions of Rivers State or Nigeria.
2. Furthermore, the study was reliant on self-reported data, which may have introduced biases such as social desirability bias, where midwives might have provided responses that aligned with expected standards or regulations.
3. Finally, logistical constraints, such as time and resources, limited the scope of the study to hospitals within the metropolis, excluding other relevant healthcare settings that could have provided a more comprehensive understanding of placenta disposal practices.

1.9 Definition of Terms

Perception:

Perception refers to the way individuals interpret or make sense of an event or phenomenon based on their experiences, beliefs, and attitudes. In the context of this study, it refers to how midwives view and understand the practices, challenges, and importance of placenta disposal within the hospitals where they work (Tversky & Kahneman, 1974). The way midwives perceive placenta disposal may influence their attitudes toward its handling and their involvement in the process.

Midwives:

Midwives are trained healthcare professionals who specialize in assisting women during pregnancy, childbirth, and the postnatal period. In this study, midwives are those involved in the clinical management of deliveries in the selected hospitals in Port Harcourt Metropolis. They play a critical role in maternal and child health, including the management of the placenta post-delivery (World Health Organization, 2014).

Placenta Disposal:

Placenta disposal refers to the proper management, treatment, and disposal of the placenta after childbirth. It includes a range of practices, from safe handling and disposal to the potential use of medical waste management procedures, to ensure that it does not pose any health or environmental risks (Lepp et al., 2017).

Hospitals:

Hospitals in this study are the healthcare institutions located within the Port Harcourt Metropolis, where midwives work and are responsible for handling placenta disposal. Hospitals are defined as establishments providing medical, surgical, or other health services and are critical in the implementation of health protocols (Okonofua & Imade, 2008).