Effectiveness of Outreach Clinical Mentoring and Supportive Supervision on Biomedical Waste Management in Nasarawa State, North Central Nigeria: An Intervention Study

Abstract

Introduction: Health care activities are essential because they restore health and save lives. At the same time however, they generate large quantity of wastes and by-products that need to be handled safely and disposed of properly. Proper health care waste handling is a worrisome issue around the world, especially in developing countries. This study is meant to determine the effect of clinical mentoring and supportive supervision on the knowledge of, attitude to and practice of biomedical waste management.  Method: A quasi-experimental study design with both qualitative and quantitative components was used. A multistage sampling technique was used to select 436 study participants who met the inclusion criteria. The data tools were pre-tested interviewer-administered questionnaires and supervisory check lists for the quantitative component on the one hand, and a focus group discussion guide for the qualitative component on the other hand. The interventions were in the form of both physical and virtual mentoring and routine supportive supervision. The participants in the control arm of the study did not receive mentoring or supportive supervision. The study lasted for 24 weeks, within which there were weekly, scheduled mentoring/supportive supervisory visits to only the facilities in the study arm.  Data Analysis: Quantitative data was collated, checked for completeness and analyzed using IBM Statistical Package for Social Sciences (version 23). Quantitative variables were described using frequencies, percentages, means and standard deviations. Chi-square test, Fisher’s exact test and Paired t test were used to test associations. At 95% confidence interval, p-value less than 0.05 was considered statistically significant. Qualitative data was analyzed using Nvivo statistiscal software, version 11.  Result: The mean age group of the study participants was 33.30(±8.97). More females (50.80%) than males (49.20%) participated in the study. Majority of the participants had tertiary education (88.45%). The predominant occupation was community health work (30.75%). In the study group, 66.4% of the respondents had poor knowledge score pre-intervention. This decreased significantly to 10.0% post-intervention (p<0.05). In the control arm of the study, there was no significant difference in the findings at the start and after the study. The proportion of respondents who had positive attitude score in the study arm, increased significantly from 40.3% before intervention to 77.8% after intervention (p<0.05). In a similar vein, the proportion with appropriate practice in the study arm also increased from 32.7% before intervention to 88.3% after intervention with a statistically significant difference. In the control arm, there was no significant difference in the findings at the beginning of the study compared to the findings at the end of the study. In the study arm, majority of the respondents who demonstrated poor knowledge of, attitude to and practice of health care waste management at the baseline focus group discussion sessions, showed significant improvement at the post-intervention sessions. In the control arm, there was no significant difference in the focus group discussion findings. Conclusion: The findings above are suggestive of the fact that the interventions were effective. There is, therefore, the need for the establishment of incentive schemes like clinical mentoring and regular supportive supervision of health care workers on health care waste management in order to safeguard human, animal and environmental health.