Unpacking healthcare waste management at rural village health clinics in the Ntcheu District (Malawi)

  • Madalitso Mmanga
  • Wales Singini
  • Veronica Di Bella
  • Mary Grace Flaherty
  • Rochelle H. HolmEmail author


Management of healthcare waste in low- and middle-income countries lacks a straightforward solution, especially where rural health services are provided. The purpose of our case study was to explore the knowledge and practices of health surveillance assistants operating at rural village health clinics in Ntcheu District, Malawi, with regard to the collection, segregation, transportion, treatment, and disposal of healthcare waste. Data were collected from 81 clinics. The results indicated that while general gaps in both knowledge and practice were observed, sharps (e.g., needles) management was generally being done well. An opportunity for scale-up was found in one clinic, in which local materials had been used to construct a low-cost innovative sharps disposal receptacle that had been modified from a pit latrine design. This study recommends waste management training suitable for rural settings, the promotion of low-cost sharps disposal receptacles using local materials, further opportunities for low-cost incinerators, central waste collection, and encouraging grassroots innovation in healthcare waste management.


Government Healthcare waste Health clinic Knowledge Malawi Rural Sharps management 



The authors greatly appreciate the technical editing by Jake Stillwell.


This work was supported by the Ntcheu District Health Office under the Ntcheu District Council.

Compliance with ethical standards

Ethical approval

Ethical clearance for the study was approved by the Malawi Government, National Commission for Science and Technology (Protocol Number P09/17/210 on 26 September 2017). Informed consent was obtained from all individual participants who were included in the study.

Supplementary material

10661_2019_7306_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Madalitso Mmanga
    • 1
    • 2
  • Wales Singini
    • 3
  • Veronica Di Bella
    • 4
  • Mary Grace Flaherty
    • 5
  • Rochelle H. Holm
    • 6
    Email author
  1. 1.Department of Water Resources Management and DevelopmentMzuzu UniversityMzuzu 2Malawi
  2. 2.Ministry of Health, National TB Control ProgramLilongweMalawi
  3. 3.Department of FisheriesMzuzu UniversityMzuzu 2Malawi
  4. 4.CDC Group plcLondonUK
  5. 5.School of Information and Library ScienceUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Centre of Excellence in Water and SanitationMzuzu UniversityMzuzu 2Malawi

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