Occupational Hazard Among Biomedical Waste Handlers in Low-Resource Settings: A Systematic Review and Meta-Analysis

Managing biomedical waste (BMW) effectively is a pressing public health challenge, particularly in low-resource settings in accordance with the World Bank classification of low- and middle-income countries (LMICs), where deficiencies in waste management infrastructure exacerbate health risks. BMW handlers face elevated occupational hazards due to inadequate safety measures, lack of training, and inconsistent use of personal protective equipment (PPE). Understanding these risks is crucial for improving health outcomes and ensuring the safety of these essential workers.

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024615074). We searched PubMed, Embase, and Scopus for peer-reviewed articles published between January 2000 and October 2024, focusing on occupational hazards experienced by biomedical waste handlers in resource-limited settings. Random-effects models were used to estimate the pooled prevalence of needle and sharp injuries, hepatitis B and C infections, and the utilization rates of PPE. Heterogeneity among studies was quantified using the I² statistic, and sensitivity analyses were performed to ensure the robustness of our findings.

Fourteen studies met the inclusion criteria. The pooled prevalence of needle and sharp injuries was 26.4%. The prevalence of hepatitis B and C among BMW handlers was 5.8% and 2.4%, respectively. PPE usage rates were as follows: masks at 76.9%, gloves at 84.9%, boots at 19.0%, and gowns at 55.4%. Only 15.3% of handlers were immunized against hepatitis B, and 57.4% had received training in BMW management. Significant heterogeneity across studies indicates variable risk exposures and safety practices.

The inconsistent use of PPE, along with low hepatitis B immunization and inadequate BMW training, highlights critical gaps in worker protection. Strengthening safety protocols, expanding training, and improving access to PPE are essential to reduce these risks. Given the substantial heterogeneity across studies, these findings should be interpreted with caution.