Placenta disposal practices among doctors and nurses in obstetric units of secondary and tertiary health facilities in Enugu State, Nigeria

Abstract

Background: Anecdotal evidence suggests that placentas may be improperly disposed of due to the lack of knowledge of the best approaches. The reason women request for their placenta in Nigeria remains unclear. Aim: The aim is to determine the knowledge and perceptions of doctors and nurses about the use of WHO guidelines for the safe disposal of hospital wastes in placenta disposal and to explore their placenta disposal practices at tertiary and secondary health facilities in Enugu state. Materials and Methods: This was a mixed-method study design in which 163 doctors and nurses drawn from 3 secondary and 3 tertiary hospitals in Enugu Metropolis were studied. Quantitative component involved the use of interviewer‑administered questionnaires. Knowledge and perceptions of respondents on the use of WHO guidelines to dispose of the placenta were documented. Knowledge of WHO guidelines was assessed and graded: good knowledge (score ≥12) and poor knowledge (score <12). Perception was assessed using 4 Likert‑type questions whose responses were scored. Mean score ≥0.5 (positive perception), mean score <0.5 (negative perception). The qualitative component involved purposive sampling of 6 nurses who were the labour ward unit heads. In‑depth interviews using semi‑structured questionnaires were conducted to ascertain their placenta disposal practices and why women request placentas in their hospitals. Analysis was done for quantitative components using IBM SPSS version 20.0. Analyses were both descriptive and inferential. Analysis of the qualitative component established three thematic areas following the transcribing and coding of the contents of the interview. Results: Thirty‑three (20.2%) and 158 (96.9%) had good knowledge (mean score = 12.7 ± 0.48) and positive perceptions (mean score = 2.96 ± 0.65), respectively, toward the use of WHO guidelines for placenta disposal. Placenta pits were the most common method for disposing of placenta. Those who request their placenta do so for cultural reasons (bury at home), avert being used for money rituals by health workers, and for the baby to be complete. Conclusion: A high proportion of doctors and nurses in Enugu state have poor knowledge but a positive perception toward WHO guidelines for disposing of placenta. The most common means of disposal was the placenta pit.