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Circularity in waste management: a research proposal to achieve the 2030 Agenda

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• Published: 21 April 2023
• Volume 16 , pages 1520–1540, ( 2023 )

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• Rocío González-Sánchez   ORCID: orcid.org/0000-0002-5460-6652 1 ,
• Sara Alonso-Muñoz   ORCID: orcid.org/0000-0001-8991-5781 1 &
• María Sonia Medina-Salgado   ORCID: orcid.org/0000-0003-3500-1241 1  

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Waste management is the main challenge in the transition away from the linear "take-make-dispose" economy. Incorporating the principles of circularity in waste management would facilitate the achievement of Sustainable Development Goals. This paper aims to provide state-of-the-art research about circular waste management in the fulfillment of the 2030 Agenda. For this purpose, bibliometric analysis by VOSviewer and SciMat software is used to define the evolution and to detect research trends. Based on the main gaps identified in studies, a research agenda to guide for further opportunities in this field is suggested. The results obtained four clusters that address sustainable industrial infrastructure, biological waste management, recycling in developing countries and recovery processes. Four research propositions are established, focusing on plastic waste management and generation trends, circular municipal waste management, more sustainable landfill management, and enablers such as indicators and legislation. The transformation towards more bio and ecological models requires social, regulatory and organizational tools that consider the best interests and capacity of companies, public authorities and consumers. In addition, policy implications are considered.

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1 Introduction

Circular economy (CE) is a regenerative and restorative system, which allows the conservation of the value of raw materials by breaking with the concept of end-of-life of products, minimizing waste and emissions and increasing efficiency, through recycling, reusing, and remanufacturing, among others (Ellen MacArthur Foundation 2017 ). This paradigm represents a further step towards sustainability supported by its three fundamental pillars—economic, environmental and social sustainability (Muñoz-Torres et al. 2018 ). The circular system is based on the principle of material balance, seeking regeneration of natural systems, which implies the minimisation of waste and pollution. In this way, changes already begin to emerge in the design phase (Foschi et al. 2021 ) and go beyond the production system, reaching the development of new patterns of consumption and use by maintaining or reusing products and materials (Vanapalli et al. 2021 ). From an environmental economics point of view, it implies that all material or waste streams must be considered (Andersen 2007 ). Products have a longer lifetime, new applications and are reintroduced into the production system, closing the loop. The social aspect is fundamental to this, and coordination and cooperation with suppliers and customers must be facilitated (Martín Martín et al. 2022 ). In addition, making this new paradigm shift requires a new behavioural and cultural framework.

Waste management involves the transportation, collection, processing, disposal or recycling of waste materials, originating from industries, manufacturing processes and municipal solid waste. This process or system presents one of the main challenges in the transition towards circular business models (Smol et al. 2020 ). CE involves a waste management system that combines changes in the entire supply chain (Johansen et al. 2022 ), from designers and choice of materials to operators and recycling issues (Salmenpera et al. 2021 ).

Circular waste management comprises both the reduction in the generation of residual and household waste, but also the reintroduction of these wastes back into the production system. This reduction is achieved through the eco-design of products, by reducing waste generated in transport, by conserving material value through recycling and by achieving a longer lifetime of products (Salmenpera et al. 2021 ). Once the waste has been generated, it must be incorporated into the production system from the CE, either by using parts or as a source of energy through the reintroduction of biological waste, thus closing the material flow cycle (Zeller et al. 2019 ).

Although interest in waste management research, applying the principles of circularity, is growing, it is necessary to know state-of-the-art research trends in this area. Previous bibliometric or analytical method studies have analysed the relationship between “circularity and “waste” or “waste management” but from a different perspective to the research conducted. Recent studies have provided a qualitative view of the relationship but from very specific aspects -considering a type of waste, a geographical area or time period or one of the dimensions of sustainability-. Some research focuses on one type of waste such as Tsai et al. ( 2020 ) who analyse the link between municipal solid waste and the circular economy or Sundar et al. ( 2023 ) who examine e-waste. Ranjbari et al. ( 2021 ) examines the application of circularity in waste management, including the “closed loop” concept, up to 2020. Circular economy and closed-loop material cycles are deeply connected; however, the concept of closed-loop material cycles arose with the beginning of industrialization (Kara et al. 2022 ). Negrete‑Cardoso et al. ( 2022 ) considers “circular economy” to be related to “waste” and its impact on the post-Covid period. Chioatto and Sospiro ( 2023 ) discuss European economic policy issues that have promoted waste management from a circularity perspective. From a systematic literature review approach Di Vaio et al. ( 2023 ) analyse the accountability and management accounting practices of waste management related to the circular economy.

Our study presents three differentiating contributions with respect to previous studies. Firstly, we focused specifically on “circular economy” and “waste management” from a holistic perspective considering environmental, economic and social aspects. Secondly, by considering the year 2021 in the period under study, this includes one of the years with the most research on the effect of COVID-19 on waste management. The unprecedented increase of waste generated by this pandemic requires further research to enable the construction of a comprehensive circular economy model (Ranjbari et al. 2023 ). Thirdly, we established a relationship between our results and their contribution to the fulfilment of the 2030 Agenda. Although previous work has recognised the contribution of circular waste management to the 2030 Agenda (Di Vaio et al. 2023 ), a full analysis of the contribution of research by specific targets has not been carried out. Further than considering the main topics of the 2030 Agenda in the different clusters obtained, this paper establishes the relationship between the Sustainable Global Goals (SDGs) associated with waste management and the different research streams found.

The purpose of this study is to provide state-of-the-art research on the relationship between circular economy and waste management. This bibliometric analysis examines the historical evolution of research and identifies trending themes to uncover the conceptual building blocks of this field. Moreover, is setting out a research agenda about future opportunities for practitioners, policymakers, and researchers. This paper contributes to filling the existing gap on scientific literature for guiding research in the implementation of circular waste management, which is fundamental to achieving the goals outlined in the 2030 Agenda. Hence, considering the current scientific literature, we propose the following research questions:

RQ1. How does the scientific literature structure on waste management and circular economy align with the 2030 Agenda?

RQ2. What are the central topics and patterns within this research field?

RQ3. What are the main research trend topics in the domain?

RQ4. What is the research proposal on the relationship between circular waste management and the 2030 Agenda?

The paper is divided as follows: following the introduction, the literature overiew on waste management and 2030 Agenda is covered, then the methodology section is presented, describing the different phases of the process. The bibliometric results are exposed as productivity measures, considering the historical evolution of documents published in the field of waste management and circular economy and the most representative journals by authors sorted by institution, country, number of documents published and total citations. Through co-occurrence analysis, using VOSviewer software and SciMat software which displays strategic diagrams and clusters with the main motor, research topic trends in the field were identified whether basic, emerging or disappearing, and developed or isolated themes. Finally, discussions and conclusions within a research agenda are presented.

2 Waste management and Sustainable Development Goals

Waste generation has increased significantly in recent years in relation to consumer patterns, activities and lifestyles. Therefore, waste management is of great environmental value (Martín Martín et al. 2022 ). Inappropriate waste generation has negative environmental, social and economic impacts in terms of damage to biodiversity and pollution, human health problems and the costs involved, respectively. Coping with the costs of environmental and social impacts must be considered worse than developing new and more efficient waste management systems (Sharma et al. 2021 ). To reduce these negative effects, the introduction of sustainable and circular issues to manage waste generation, and the collection of waste throughout the life cycle of products is required (Tsai et al. 2021 ). This need has been accentuated by recent crises in areas such as health, safety and energy during 2021 and 2022 (Vanapalli et al. 2021 ; Gatto 2022 ; Mišík 2022 ). However, these adverse historical events provide an opportunity for reflection, forcing governments and businesses to promote long overdue energy and ecological transition policies and practices (Gatto 2022 ; Mišík 2022 ). Given the need to consolidate this trend, the implementation of circularity enhances sustainability and requires a new vision in waste management (Minoja and Romano 2021 ).

In 2015 the United Nations adopted Agenda 2030 as a roadmap to achieving higher levels of sustainability, striving towards satisfying its 17 Sustainable Development Goals (SDGs) with the commitment of public actors, industry and society (Schulze et al. 2022 ). Several theories have been used in the literature to analyse these SDGs. Resource-based theory regarding natural resources is widely studied to examine waste practices that protect the environment (Agyabeng-Mensah et al. 2021 ). Due to the environmental impacts, some of the theories focus on pro-environmental attitudes and behaviour, such as social-practice theory (Munir 2022 ) and the theory of planned behaviour (Goh and Jie 2019 ). Regarding the association between SDGs and supply chains, a redesign towards sustainable practices is required. Transactions and economics theory have highlighted the need for changes to the decision-making process during production cycle stages to achieve sustainability goals. In addition, stakeholder and agency theories enable the achievement of SDGs, since both the collaboration and the alignment of interests in fulfilling the 2030 Agenda are required (Agrawal et al. 2022 ).

The relationship between waste management and the 2030 Agenda is closely linked, as it affects many SDGs. It is therefore essential that this relationship be studied. According to SDG 2, the listed items of: ‘end hunger, achieve food security, improved nutrition and promote sustainable agriculture’ require, among other factors, the minimisation of food loss and food waste to achieve efficient and sustainable agricultural production. Similarly, factors such as increasing food availability or achieving more resilient food systems would facilitate this goal (Wieben 2016 ). SDG 3, ‘Ensure healthy lives and promote well-being for all at all ages’, in order to reduce illness linked to water, pollution and hazardous chemicals by means of smart waste management (Fatimah et al. 2020 ). SDG 6 ‘ensure access to water and sanitation for all’ aims to reduce the percentage of untreated wastewater and increase recycling and reuse (Tortajada 2020 ). SDG 7 ‘ensure access to affordable, reliable, sustainable and modern energy’ proposes increasing the use of renewable energy and facilitating access to research on clean energy, including renewable sources (Taifouris and Martín 2023 ). SDG 9 ‘build resilient infrastructure, promote sustainable industrialisation and foster innovation’ advocates for the modernisation and conversion of industries towards cleaner and more sustainable models as they are required to use resources more efficiently and rationally (Dantas et al. 2021 ). SDG 11 ‘make cities and human settlements inclusive, safe, resilient and sustainable’ focuses on building more sustainable cities, with particular attention to air quality and municipal and other waste management. This also implies resource efficiency and waste generation-collection services (Sharma et al. 2021 ). SDG 12, ‘ensure sustainable consumption and production patterns’ seeks to achieve the sustainable management and efficient use of natural resources. This goal emphasises the importance of reducing different types of waste throughout the life cycle of a product or service through prevention, reduction, recycling and reuse activities (Principato et al. 2019 ). With regard to agro-food waste, a reduction of both food losses and food waste in the production and supply chains is proposed. SDG 13, ‘take urgent action to combat climate change and its impacts’, can affect waste treatments relevant to their environmental impact through using greener and cleaner technologies, such as anaerobic digestion (Kakadellis et al. 2021 ). SDG 14, ‘conserve and sustainably use the oceans, seas and marine resources’ is also linked to plastic waste management, according to marine pollution minimisation. SDG 15, ‘sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss’ can be mitigated by protection and restoration, avoiding landfill waste. Finally, SDG 17 ‘revitalise the global partnership for sustainable development’, can be enhanced owing to waste treatment development, enabled by new treatments technologies (Sharma et al. 2021 ).

SDGs achievement is a priority and takes on even greater importance considering the fact that eight years prior to the deadline set in the 2030 Agenda, some reports show that we are still far from meeting most of the goals. The Food and Agriculture Organisation (FAO) estimates that around 35% of employment is a direct result of food systems and the promotion and implementation of sustainable practices in the food system -including food waste and loss- which is still low, referring to unfulfilled SDG 2 (Torero 2020 ). Uncollected waste is one of the major issues. In terms of municipal solid waste management, proper collection is key, as mismanagement of these services can lead to dumping into waters, which directly affects SDG 6 achievement (Sharma et al. 2021 ). To enable both sustainable energy and industrialisation a transition towards the use of renewable and cleaner energy is necessary. Waste can be adopted as an energy resource, such as biomass waste and pyrolysis (Moya et al. 2017 ). However, fossil fuels are still strongly present in several industries, which negatively impact on SDG 7, 9 and 11. Waste management systems’ disruptions in relation to current situations -COVID-19 pandemic and supply crisis- have minimised recovery and recycling activity. For instance, the plastic waste proliferation caused by the pandemic resulted in both water and air pollution, due to poor and non-effective waste management. Thus, SDG 12, 13 and 14 premises are failing (Sharma et al. 2021 ). This also adversely affects halting biodiversity loss and the land degradation (SDG 15). In addition, there are advances in waste treatment thanks to new technologies which are starting to be implemented. For instance, anaerobic digestion and waste-to-energy technologies (Moya et al. 2017 ), but their application is still scarce, not satisfying SDG 17. Consequently, there is an urgent need to take additional measures to facilitate the implementation of the various sustainable measures included in the plan.

3 Methodology

This study combines a bibliometric analysis carried out by VOSviewer and SciMat software, and an in-depth literature review of the articles published during the year 2021. Figure  1 shows the phases of this work: Phase 1) data collection, phase 2) bibliometric analysis, and phase 3) systematic literature review and research agenda.

Methodological process

3.1 Data collection

In the first phase, documents from the Web of Science Core Collection database were collected from the period 2009 up to September 2021. The keywords used were ‘circular economy’ and ‘waste management’. This generated a total of 1.395 papers. Then, it was selected articles by topic, which includes title, abstract and authors’ keywords. retrieving 966 documents. Thereafter, we sorted the data into groups of Social Sciences Citation Index, Science Citation Index Expanded, Arts and Humanities Citation Index, taking only articles into consideration, reaching a total sample of 576 articles that were extracted and including in this analysis after a double checked in order to eliminate inconsistences.

3.2 Bibliometric analysis

Bibliometric methodology identifies research trends providing the knowledge structure about a specific field. By examining recent published articles, network analysis shows emerging fields (Hettiarachchi et al. 2022 ). In the second phase, bibliometric approach was performed using VOSviewer and SciMat software to understand the latest trends in the fields of waste management and circular economy. VOSviewer is more visual and allows for the examination of co-occurrence, analysis of authors, institutions and countries (Van Eck and Waltman 2010 ). In this paper, SciMat completes VOSviewer analysis since it carries out the co-occurrence analysis in time periods and the evolution of these periods can be seen on an evolution map. Additionally, SciMat illustrates strategic diagrams which uncover the main research themes (Cobo et al. 2012 ). Furthermore, it allows one to observe the clusters of each keyword, making the analysis more complete and comprehensive.

Following on from this, VOSviewer conducts a citation analysis of the most representative journals and the most prolific authors and from here, a co-occurrence analysis is displayed. Via the SciMat tool a co-word analysis is also developed, displaying the strategic diagrams and clusters with relevant keywords, divided up into three periods according to the number of documents published, years 2009–2019 (Period 1), 2020 (Period 2) and 2021 (Period 3).

In the third and last phase, a literature review of the articles related to circular economy and waste management is carried out, in accordance with 51 documents from the motor themes of the SciMat analysis in the third period, during the year 2021, to determine the latest trends and research in the field. Finally, a research agenda is exposed regarding trending topics analysed in this work.

4 Bibliometric results and productivity measures

Figure  2 shows the historical evolution of documents published in the field of waste management and circular economy from 2009 to September 2021, considering a total sample of 576 articles. Waste management towards circularity is gaining momentum in academia according to the number of documents published in the field since 2015, coinciding with ‘The 2030 Agenda for Sustainable Development’ (United Nations 2015 ). In addition, other European strategies and legislative challenges took place, such as ‘Communication on closing the loop. An EU action plan for the Circular Economy’ (European Commission 2015 ) and ‘Communication on a monitoring framework for the Circular Economy’ (European Commission 2018 ) considering waste management as one of the main challenges in the transition to circular business models.

Historical evolution of publications in the field of waste management and circular economy

Table 1 shows the ten most representative journals sorted by number of total documents published and citations. These journals represent 60,25% of the total sample formed by 132 sources. The Journal of Cleaner Production is the most influential with 79 articles published in the field of circular economy and waste management, and a total of 1.343 cites. It should be noted that almost all sources belong to the "environmental sciences" category. None of the most cited journals belong to the social sciences.

The most influential authors are sorted by number of documents published and total citations, indicating the institutions and country which they work in, and the h-index –impact and productivity measure-. The most prolific author is Navarro Ferronato from the University of Insubria in Italy with 9 papers published and a total of 129 cites, followed by Vicenzo Torreta (8, 129) from the same institution. The prevalence of Italian researchers is in line with the country's overall recycling rate for all types of waste which reaches 68%, well above the EU average (57%) published in the “Third Report on the Italian circular economy in 2021” (ENEA 2021 ). Additionally, in 2020 several legislative decrees came into force that facilitated the implementation of EU directives on waste and the circular economy.

Institutions include the University of Hong Kong whose role in integrated and sustainable waste management is significant both at the research level (Hossain et al. 2021 ) and practical level in running the campus and encouraging waste reduction and recycling among all stakeholders (The University of Hong Kong 2021 ).

5 Research trend topics in the field

5.1 co-occurrence analysis by vosviewer software.

Co-occurrence analyses the most frequent keywords in a research field regarding their jointly mention, represented by clusters (Callon et al. 1983 ). This method is widely used to identify research trend topics about a particular subject area according to the keyword frequency (Donthu et al. 2021 ). The closer two items are from each other, the higher the connection. Accordingly, those keywords with a higher association appear closer.

This analysis used the full counting network technique which points the total number of occurrences a concept appears in all documents. The normalisation parameter method with association strength was performed by VOSviewer, to normalise the link strength between keywords (Van Eck and Waltman 2010 ).

Performing the analysis, different occurrence thresholds have been used to observe the network structure. VOSviewer software permits to perform a data cleaning to visualise a map created by text data merging terms using a thesaurus file (Van Eck and Waltman 2010 ). In our co-occurrence analysis we created a thesaurus to merge different keywords referring to the same item, such as ‘LCA’ and ‘life cycle assessment’, or ‘municipal solid waste’ and ‘municipal-solid waste’. Finally, a minimum of 13 occurrences of a keyword has been chosen from 2.868 words. 41 keywords met the threshold that represents the main items of each cluster. The keywords are divided up into main four groups of clusters coloured in red, green, blue and yellow in Fig.  3 . The red cluster named ‘Industrial ecology and more sustainable infrastructure’ -SDG 9- focuses on the circular economy and industrial ecology with the aim of making industrial buildings and construction and demolition waste more sustainable, and on the challenges and barriers posed by these new models. The green cluster ‘Waste management through biological and assessment processes’ -SDGs 6, 7, 11 and 12- links the food waste and municipal solid waste and how anaerobic digestion and biogas can achieve a reduction in the use of energy and low emissions. Water treatment is associated with optimisation through new technologies. These studies use the life cycle assessment as a main tool for measurement. Sustainable development and recycling, considering indicators and behaviors in developing countries are shown in the blue cluster named ‘Sustainable development and recycling in developing countries’ -SDG 12-. Finally, the cluster in yellow studies the need to establish new policies and designs that would allow for improved waste management through resource recovery, such as the extension of producer responsibility beyond the sale of the product or service. It is therefore titled ‘New procedures for the recovery of resources’ -SDG 12-.

Co-occurrence analysis of keywords by vosviewer

5.2 Strategic diagrams and motor themes by SciMat software

Science mapping analysis displays how items from a particular field are linked to each other, determining the evolution and cognitive structure (Small 1999 ). In this study, keywords are the items used. The bibliometric mapping tool used to show the strategic diagrams is SciMat software. From the set of documents, it generates a knowledge base, in this case, the relationships between keywords are stored following a co-occurrence analysis. SciMat software grouped by plural to find similar items during the de-duplicating process (Cobo et al. 2012 ). For instance, keywords such as system and systems.

SciMat tracks a longitudinal framework that analyses the conceptual and intellectual evolution of a field. The normalisation measure chosen was the equivalence index. And to obtain the scientific map and the associated clusters and subnets, the clustering algorithm method followed was simple centers algorithm. The analysis is performed dividing the sample into three periods: period 1 with a total of 214 articles of year 2009 up to year 2019, period 2 with 155 articles of the year 2020, and period 3 with 189 articles of the year 2021. From a sample of 2,819 words, a total of 77 words have been considered, selecting only keywords with a minimum of 10 associated documents. As can be seen in Fig.  4 , the stability index (0.99 and 0.99) indicates that there is a balance between the number of words from one period to the next.

Overlapping map. Periods 1, 2 and 3 by scimat software

The evolution map shows the results of the longitudinal analysis. The thick lines show the clusters that share a main theme, and the dashed lines are those that share themes other than the main theme (Cobo et al. 2012 ). In the first period the motor theme is circular economy, while in the second period the focus is on municipal solid waste.

Figure  5 shows the difference between periods 1 and 2, from the more general to the more specific, with municipal solid waste oriented towards sustainable development -SDG 11-. In the third period focus returns to circular economy, with more dispersion apparent than in period 2, yet more specificity, as the number of clusters expands again. The massive generation of plastic waste generated during COVID-19 (Khoo et al. 2021 ; Vanapalli et al. 2021 ) could explain the interest in municipal solid waste management during period 2 and the emergence of concepts with plastics management in period 3. As a result, an evolution from the first period can be observed, with a strong focus on the implementation of circular economy and energy generation towards a circular economy centered on municipal solid waste.

Evolution map. Periods 1 and 2 by scimat software

This analysis is focused on the third period to gain better attention about the recent evolution of this field. Figure  6 shows a strategic diagram of Period 3 (year 2021) with four quadrants of the main thematic nodes according to the co-word analysis performed by SciMat. The strategic diagram displays the motor themes: ‘circular economy’, ‘life cycle assessment’ and ‘China’, developed thereafter, the basic themes: ‘recovery’ as a very specific and underdeveloped topic, it suggests a strategy towards circularity that is beginning to be considered, because many policies were only focused on promoting recycling (Ghisellini et al. 2016 ). The emerging or disappearing themes: ‘generation’, an emerging theme related to e-waste which is working on the reuse of products -SDG 12-, but circular economy is not applied in-depth. Regarding sustainable development and waste management, the environmental impacts are still a very large gap in the literature; ‘plastic waste’ is an emerging theme for circular economy, and it is studied within the pyrolysis and recycling process and new designs to improve the circularity -SDG 9 and 12-. ‘Sector’ appears as an isolated theme from circular economy, the literature is very cohesive in density due to its links with waste management case studies in different industries -SDG 9-.

Strategic diagram. Period 3 (2021) by scimat software

Based on Fig.  6 ‘circular economy’, ‘China’ and ‘life cycle assessment’ appear as motor themes. These keywords present high density and centrality, thus they have been intensively and highly studied in literature. Which is why the following analysis is focused on them. ‘Circular economy’ is linked with ‘sustainability’ and ‘sustainable development’ according to the origin of circularity (Ghisellini et al. 2016 ). Likewise, the keyword ‘recycling’ relates to circular economy as a part of 3Rs principles, due to circular policies and their focus on recycling practices and strategies rather than other options -SDG 12-. ‘Municipal solid waste’ and ‘management’ is one of the most developed topics in the studies analysed and published during 2021 towards circular economy -SDG 11-.

‘China’ is a pioneering country in the implementation of circular economy policies, and strategies based on sustainability (Lieder and Rashid 2016 ). From a broad CE perspective, the country has incorporated these schemes due to the country’s rapid industrialisation and its growing efforts in research (McDowall et al. 2017 ). Indeed, the country is the largest producer of municipal solid waste (Wang et al. 2021 ) increased by COVID-19 (Vanapalli et al. 2021 ) and given its large industrial sector. The country is developing research that allows it to establish symbiotic relationships, to find new ways of using resources or converting waste into energy -SDG 7, 9 and 11-. It would be framed within the so-called industrial symbiosis, defined as the process by which waste from one industry or industrial process is converted into raw material for another (Provin et al. 2021 ).

‘Life cycle assessment’ appears far removed from circular economy, focusing more on waste demolition and construction management (Ahmed and Zhang 2021 ; Lu et al. 2021 ) -SDG 9-, and on plastic waste generation (Hossain et al. 2021 ; Pincelli et al. 2021 ).

6 Review analysis

A systematic literature review was performed, considering the core documents with highest impact –those that appear at a minimum two nodes (Cobo et al. 2012 )- from SciMat report. Selecting those articles from the three clusters that are presented as motor themes for period 3 (year 2021): ‘circular economy’, ‘China’ and ‘life cycle assessment’. Firstly, it was considered those papers with at least one citation (N = 51). Secondly, an in-depth analysis of those articles was carried out, compiling findings and future research lines of the 20 leading articles by number of citations (Table 2 ) according to the SciMat core documents.

Citation analysis is a measurement widely used that considers a paper highly cited as relevant in a field (Zupic and Cater 2014 ), enabling us to evaluate the influence of a research topic. Also is used as a tool to detect emerging and research trends (Chen 2006 ).

Municipal Solid Waste (MSW) -SDG 11- is one of the main topics. Many of the papers related are case studies such as Vardopoulos et al. ( 2021 ) which developed a Driver-Pressure-State-Impact-Response (DPSIR) model to evaluate and assess the Municipal Solid Waste practices in Greek municipalities. Abou Taleb and Al Farooque ( 2021 ) concentrate on full cost accounting in 27 Egypt councils designing pricing model ‘Pay-As-You-Throw (PAYT)’ for municipal waste recycling. Wielgosinski et al. ( 2021 ) performed an analysis of the Polish municipal solid waste management through a balance model for assessing the impact of increasing the level of recycling, whilst Istrate et al. ( 2021 ) studied the municipal solid waste management in Madrid with a material flow analysis. Similarly, Tong et al. ( 2021 ) analyses the solid waste management system and the cause-effect relationship of households in Vietnam. Di Foggia and Beccarello ( 2021 ) highlighted the fact that the waste management chain in Italy focuses on waste-to-energy plants, calculating market measures towards circularity. In addition, in the region of Brescia, Italy, Bertanza et al. ( 2021 ) examined the evolution of municipal solid waste evolution with mass flow analysis of medium firms. Solid waste management in Brazilian universities is explored in the Nolasco et al. ( 2021 ) paper, which developed a qualitative-quantitative analysis, identifying factors of university campus waste management.

Plastic waste management is greatly studied in connection with circularity practices in many of the articles published during 2021, such as the case studies carried out by Foschi et al. ( 2021 ) on the Emilia Romagna plastic waste recycling system, following the European Commission Plastic Strategy. Similarly, Wu et al. ( 2021 ) outlines how Taiwan achieves circular economy in plastic waste from an industrial level, owing to collective bricolage. Some of the papers outline COVID-19 and the excessive use of plastics, coinciding with the most cited article of the sample (Vanapalli et al. 2021 ) which address COVID-19 plastic waste generation and the use of more sustainable technologies. The Khoo et al. ( 2021 ) paper provides recommendations for adopting effective plastic waste management due to excessive use during the COVID-19 pandemic. Pikon et al. ( 2021 ) shows the influence of COVID-19 on waste management from an economic impact perspective, highlighting the changes in municipal solid waste during the pandemic in the Polish market. Furthermore, increasing attention is being paid to biodegradable plastics as an alternative to conventional plastics. Ghosh and Jones ( 2021 ) examine upcoming trends, potential future scenarios, and the material value chain perspective of biodegradable plastics, whilst Kakadellis et al. ( 2021 ) categorizes qualitative data about biodegradable plastic strategies in United Kingdom -SDG 12-.

In the studies examined, the management of food waste is also analysed -SDG 11 and 12.- Zarba et al. ( 2021 ) analyses the Italian agri-food effectiveness towards circular economy regulatory; Provin et al. ( 2021 ) examines the reuse of food industry waste for the manufacture of biotextiles in the framework of the circular economy and the SDGs. This inter-industry collaboration would be part of the industrial symbiosis referred to above -SDG 9-.

In a similar vein, and related to SDG 9, the last process analysed by the most cited studies is the pyrolysis process, which allows thermal degradation of waste, associated with landfill mining, extracting valuable materials from the remains of materials deposited in landfills (Jagodzinska et al. 2021 ). Martínez ( 2021 ) discusses the opportunities and challenges of pyrolysis in Latin America.

7 Discussion

This section is based on the results obtained from the bibliometric clusterisation, and the review of the 20 most cited articles. The number of articles published in the field have increased since 2015, corresponding to the United Nations Agenda 2030 and the 17 Sustainable Development Goals focused on improving and achieving education, health, economic growth and reducing inequality, as well as preserving forests and oceans (United Nations 2015 ). It is also remarkable to note the growth between years 2019 and 2021 due to new strategies and worldwide circular policies implemented in the field of waste management, such as the ‘Circular Economy Action Plan for a greener and more competitive Europe’ based on the prevention of waste and seeking improved local waste and raw material management (EU 2020 ; Camana et al. 2021 ). Although the "Agenda 2030" or "SDG" themes were not found in any of the clusters, the rest of the themes are closely related to their fulfilment. Moreover, circular waste management not only contributes to several SDGs, but also creates synergies between the goals.

A significant trend in the literature has focused on waste recycling (SDG 11 and 12), which is essential, yet insufficient if sustainable production and consumption is to be achieved by 2030. The main research topics analysed in the articles published during year 2021 focus on (1) Municipal Solid Waste (MSW) with the design of new municipal waste recycling models such as the Pay-As-You-Throw (PAYT) pricing model (Abou Taleb and Al Farooque 2021 ), (2) the importance of plastic waste (Khoo et al. 2021 ) and its recovery as a tool in the implementation of circularity principles (Ferreira et al. 2021 ), increased by the generation of plastic waste during the COVID-19 pandemic (Khoo et al. 2021 ), and (3) the reduction of food waste or its application in bio-textiles (Provin et al. 2021 ) or as an energy source -SDG 9 and 11-.

Going one step further should be considered in achieving further targets of this goal. On the one hand, a reduction in waste generation and a search for more sustainable disposal options for waste that cannot be recycled are required, e.g., through new processes such as waste pyrolysis (Jagodzinska et al. 2021 ) -SDG 9-. On the other hand, extending the lifetime of products by finding additional, new uses for them, eliminating planned obsolescence or repairing the product at a cost lower than buying a new product (Ghisellini et al. 2016 ) -SDG 12. Complementarily, waste generated in one sector can be used as a raw material in another sector or as a source of energy in the case of organic waste -SDG 7 and 9-.

8 Research agenda

The research agenda provides guidance to scholars in future related-research directions. The agenda is based on the previous in-depth analysis of the 20 articles included in the review. Considering the analysis and the ensuing discussion, the following proposal is put forward for the circular management of waste management to accelerate the fulfilment of the 2030 Agenda. Moreover, this could fill gaps and give opportunities for further development. Figure 7 collects the research agenda propositions.

Research agenda propositions diagram

8.1 New trends in plastic waste management and generation (SDG 12)

One of the most researched materials in the most cited papers is the use of plastic -6 of the 20 papers analyse this issue-. Firstly, because of the significant increase in waste associated with it after COVID-19 (Vanapalli et al. 2021 ; Khoo et al. 2021 ). Secondly, because of the need to progressively replace it with other materials such as biodegradable plastics, which implies the use of renewable raw materials. In short, solutions must be proposed to current plastic waste, the quantity of which threatens the habitat of numerous species, and measures must be taken to curb its expansion and offer alternatives in sustainable materials.

It is worth noting that no studies have been found that analyse the legislative challenges associated with the progressive elimination of plastic in products such as bags or single-use items.

Proposition 1: To deepen new trends in plastic waste management and generation.

8.2 New pathways in the circular management of municipal waste (SDG 7, 9, 11 and 12)

The second line of the proposal relates to circular municipal waste management -SDG 11-, a topic of great interest in recent research (Abou Taleb and Al Farooque 2021 ), growing due to recent global crises. However, the approach that has analysed this topic focuses mainly on waste recycling.

A broader focus is needed, considering other alternatives such as the reduction of waste generation, reuse and the use of Organic Fraction of Municipal Solid Waste (OFMSW) as a raw material or energy source in other sectors. Compared to incineration, which is highly polluting if the organic waste is mixed with other types of waste, there are more sustainable and energy-efficient alternatives such as anaerobic digestion (Kakadellis et al. 2021 ) -SDG 7-. This requires consumer awareness and training –SDG 12- in waste separation, adequate facilities for the process and greater cooperation between industries (Foschi et al. 2021 ; Vanapalli et al. 2021 ) For the latter option, it is recommended that tools such as industrial symbiosis be explored in greater depth -SDG 9-.

Proposition 2: To expand the alternatives towards more sustainable options in municipal waste management with the cooperation of consumers and industries.

8.3 Towards more sustainable landfill management (SDG 7, 9 and 11)

In contrast to traditional landfill management, new infrastructures, treatments and smart technologies are proposed to improve recycling and waste disposal. Among them, (1) the construction of waste-to-energy plants makes it possible to burn solid waste to power electricity generators (Di Foggia and Beccarello 2021 ) –SDG 7-; (2) pyrolysis process for thermal degradation of waste, reducing waste accumulation (Jagodzinska et al. 2021 ) –SDG 11- or (3) Industry 4.0 can be applied in waste treatment -SDG 9- for more efficient technique of separation models in waste management addressing circular economy practices (Wang et al. 2021 ). This line of research has a profound relationship with municipal waste management, given the importance of municipal waste in current landfills.

Proposition 3: To improve the operation and efficiency of landfills through new infrastructures, treatments and technological tools.

8.4 Establishment of enablers in the implementation of circularity: Design of indicators and development of legislation (SDG 12)

Optimising waste management processes requires the establishment of measurement indicators. These indicators should be of a different nature and go beyond the economic or environmental quantification of targets. They should include social aspects such as awareness raising (Loizia et al. 2021 ; Van Straten et al. 2021 ). Additionally, along with technological and economic tools, the creation of a legislative framework is a critical factor in the implementation of circularity in waste management operations (Salmenpera et al. 2021 ; Woodard 2021 ).

Proposition 4: Establishment of measurement and policy enablers.

9 Conclusions

Circular waste management focuses on reducing the amount of waste generated and reintroducing the waste, once treated, as new material or energy in production, keeping the material in a cyclical flow within the same or another sector (Demirbas 2011 ; Salmenpera et al. 2021 ). It, therefore, implies reaching a new level of treatment, complementing the recycling option with a holistic view of the problem. The application of circularity principles in waste management can contribute significantly to the fulfilment of the 2030 Agenda, as it impacts several of the SDGs -6, 7, 9, 11 and 12-.

According to the research questions presented, the scientific literature structure of the field of waste management and circular economy (RQ1) has been analysed, showing that the most productive sources come from the field of environmental sciences, which conditions the main topics investigated and shows a clear lack of attention to social sciences. The most prolific authors come from two countries with a strong interest in environmental research in general and waste management in particular—Italy and China. In the case of China, this is due to its strong productive fabric and a prominent role in the generation of waste from the COVID-19 pandemic.

Concerning RQ2, four clusters have been obtained related to industrial ecology -SDG 9-, waste management from the application of bio-based processes -SDGs 6, 7, 11 and 12-, water treatment, sustainable development and recycling in developing countries -SDG 12- and the cluster on new procedures for the recovery of resources -SDG 12-.

To conduct analysis of the central topics and the patterns we used SciMat software, dividing the articles published in the field into three periods (2009–2019, 2020 and 2021) showing the scientific literature development, as can be seen in the evolution map (Fig.  5 ). The motor themes showed in the strategic diagram of the third period are circular economy, life cycle assessment and China; recovery is a basic theme; the emerging themes are generation and plastic waste; and sector is a developed theme. Referring to RQ3, the results provided from the systematic literature review are in line with the central topics pointed out previously. Many of the studies published during 2021 pertain to motor themes circular economy and China, and to plastic waste as an emerging theme.

The most cited articles and the previous bibliometric analysis have shown the great interest generated among scientists in the management of urban waste and plastic waste, which has increased in the last two years in relation to sanitary waste. The circular economy means that recycling is not enough in the management of this waste. In addition to the reduction in the generation of waste, the incorporation of the "bio" concept in its treatment, which allows fibres, bioplastics and other biomaterials to be obtained, has been added. Along the same lines, the treatment of food waste allows it to be converted into animal feed, biofuels or even textiles. However, among the most cited articles, no research related to the use and recycling of wastewater was found -SDG 6-. Further research is needed to enable its use for biomass production or as a source of nutrients for micro-organisms of interest (Kaszycki et al. 2021 ).

The establishment of three research propositions completes this research (RQ4). In this way, it is crucial to develop three fundamental aspects. First, the use of new technologies to meet the various needs raised. Secondly, a new approach to urban waste management is required. And thirdly, to develop research from a holistic perspective that will require the use of theories and sciences from the environmental, social and economic fields.

9.1 Theoretical contributions

The results of this study offer academic contributions about circular waste management. Among the theoretical contributions is the establishment of state-of-the-art research on waste management linked to the circular economy, which will guide future research and fill existing gaps. To offer the most complete research review possible, a mixed methodology—bibliometric and systematic review of the most cited recent research—has been used. A bibliometric analysis was carried out with two software tools, taking advantage of the potential of both. Using complementary software validates the analysis results. In addition, this article provides a framework for research as a guiding point in waste management.

Thus, lack of social research is a major drawback that requires urgent incorporation of new social or multidisciplinary studies. It can be considered that social and economic issues have not been sufficiently addressed in the literature. None of the clusters obtained have these dimensions as their motor theme. Dropping SDGs such as 8 -decent work and economic growth-.

9.2 Practical contributions

A guideline for practitioners about circular waste management is required. Findings reveal the need for a reference framework for scholars, practitioners and institutions.

This article implies practical contributions for governments to achieve a transition towards more circular waste management. The research shows the technical feasibility of substituting certain materials, mainly plastic, or applying techniques that allow a step beyond recycling. It is necessary to focus on actions based on recovery, reduction, remanufacturing and redesign of plastic waste to fill this gap (Olatayo et al. 2022 ). Highlight the policy spillover effect, which means that support for some public fees—for example, plastic bag fees—may imply greater support for other environmental policies related to waste reduction (Thomas et al. 2019 ). This could facilitate positive transitions towards environmental behavioural changes. In addition, public–private coordination is required in the implementation of new legislation (Foschi et al. 2021 ).

The significant "bio" trend has spread to different types of waste and sectors. Thus, the circular management of waste will require the development of infrastructures, technologies and processes oriented to its application, which means waste management with less environmental impact, but also a generation of value of the product derived from the waste. This value can be manifested in new products -whether or not related to the original sector of the product from which the waste is derived- or renewable and sustainable energies (Ferreira et al. 2021 ; Kaszycki et al. 2021 ). For this, these processes require the establishment of cooperation tools between industries in such a way that we can establish symbiosis between them (Provin et al. 2021 ).

9.3 Limitations and future research lines

Addressing the limitations of this study, it’s worth underscoring the fact that WoS was the exclusive Database used to retrieve the final sample under analysis, and only articles published in English are studied, other languages were not considered. Despite the use of VOSviewer to display the co-occurrence analysis, the interpretation of the results is subjective, in accordance with the papers reviewed. In future works, other software can be combined such as CiteSpace or HistCite to visually create scientific maps.

Regarding future research lines, the following aspects are considered a research agenda in the field of waste management and circular economy. The need to incorporate into waste management from a circular perspective such as: circular bioeconomy models, the construction of more robust eco-efficiency indicators to improve measurement and comparison between regions, and the consideration of new processes and techniques in the management of urban, food and plastic waste. Research is also required to manage waste in the construction and demolition of buildings and infrastructures from a sustainably innovative standpoint.

The challenges facing waste management in meeting the 2030 Agenda are considerable. Circular economy facilitates the pathway but is not a miracle tool. The contribution of companies and industries requires the collaboration and awareness of consumers. To this end, public institutions must generate policies, regulations and incentives that create the most favorable framework possible. Having already surpassed half of the set timeframe towards meeting the SDG targets, urgent measures are required, and the Academy must lend its support in this regard.

Data availability

Data was retrieved from Web of Sciences database.

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Household solid waste management practices and perceptions among residents in the East Coast of Malaysia

• Widad Fadhullah   ORCID: orcid.org/0000-0003-4652-0661 1 , 2 ,
• Nor Iffah Najwa Imran 1 ,
• Sharifah Norkhadijah Syed Ismail 3 ,
• Mohd Hafiidz Jaafar 2 &
• Hasmah Abdullah 1 , 4  

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Poor waste disposal practices hamper the progress towards an integrated solid waste management in households. Knowledge of current practices and perception of household solid waste management is necessary for accurate decision making in the move towards a more sustainable approach. This study investigates the household waste practices and perceptions about waste management in Panji, one of the sub-districts in Kota Bharu, Kelantan, Malaysia.

A stratified random sampling technique using a cross-sectional survey questionnaire was used to collect data. A total of 338 households were interviewed in the survey and data were analyzed using SPSS. Chi-square goodness of fit test was used to determine the relationships between categorical variables, whereas Chi-square bivariate correlation test was performed to observe the correlation between the perceptions of waste segregation with socio-demographic background of the respondents. The correlation between perception of respondents with the locality, house type and waste type were also conducted. Principal component analysis was used to identify grouping of variables and to establish which factors were interrelated in any given construct.

The results of the study revealed that 74.3 % of households disposed of food debris as waste and 18.3% disposed of plastic materials as waste. The study also showed that 50.3% of the households segregate their waste while 49.7% did not. About 95.9% of the respondents were aware that improper waste management leads to disease; such as diarrhea and malaria. There were associations between locality, age and house type with waste segregation practices among respondents (Chi-square test, p<0.05). Associations were also found between locality with the perception of improper waste management which lead to disease (Chi-square test, p<0.05). Principal Component Analysis showed that 17.94% of the variance has high positive loading (positive relationship) with age, marital status and, type of house.

This study highlights the importance to design waste separation programs that suit the needs of targeted population as a boost towards sustainable solid waste management practices.

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Solid waste management (SWM) in the majority of developing countries including Malaysia is dominated by open dumping due to lower capital, operational and maintenance cost in comparison with another disposal method [ 47 ]. This non-sanitary and non-engineered approach are without appropriate liners, gas collection and leachate collection and treatment, thereby exposing the surrounding environment with multiple air, water and soil pollution issues [ 15 , 23 ]. The effects of the ineffective management of household solid waste on public health (Fig. 1 ) can be separated into physical, biological, non-communicable diseases, psychosocial and ergonomics health risks [ 6 , 51 , 77 ]. Contaminated soil, air and water provide breeding ground to biological vectors such as flies, rodents and insects pests. Many diseases are sequentially caused by these biological vectors, such as diarrhoea, dysentery, gastrointestinal problems, worm infection, food poisoning, dengue fever, cholera, leptospirosis and bacterial infection; irritation of the skin, nose and eyes; as well as respiratory symptoms [ 25 , 41 , 42 , 52 ]. Exposure to gases generated by landfill waste such as methane, carbon dioxide, sulphur dioxide and nitrogen dioxide can produce inflammation and bronchoconstriction and can affect the immune cell. Hydrogen chloride and hydrogen fluoride released from the waste if deposited in the respiratory system, may cause cough, chest tightness and breathlessness [ 21 ].

Effect of ineffective household solid waste management on public health

Another category of health effects that can be closely related to household solid waste management is non-communicable diseases. Some studies estimated that the pollutions from the dumpsite might cause cancers (e.g. liver, pancreas, kidney, larynx) and non-Hodgkin lymphoma [ 8 , 31 , 51 ]. Other health effects under this category worth mentioning are birth defects, preterm babies, congenital disorders and Down’s syndrome [ 51 , 52 ]. Apart from physical and biological effects, inefficient household waste management can lead to psychosocial effects such as disturbing odour, unsightly waste, and thinking, cognitive and stress-related problems [ 6 , 51 , 52 , 74 , 77 ]. Ergonomics is the final category of related health effects that is worth mentioning specifically for the working community of household waste management (Fig. 1 ). The risk of ergonomic issues is related to body posture, repetitive movement and excessive force movement [ 6 ].

Majority of the solid waste generated in Malaysia composed of organic waste with high moisture content [ 43 ], hence, the handling and waste separation at source is the most critical step in waste management [ 62 ]. The increasing amount of waste generated annually is also intensified by lack of land for disposing waste, questioning the sustainability of the current municipal solid waste (MSW) practices of using landfills [ 46 ]. Nevertheless, the lack of success in public participation to manage the solid waste is primarily rooted by the NIMBY (not in my backyard) attitude and the public perception that solid waste is a local municipal problem is highly prevalent among Malaysians [ 3 ]. Thus, most of the existing waste segregation practices by waste-pickers are mostly done in the informal sector as means of livelihood for the poor and additional source of income. On the other hand, this practice causes serious health problems, aggravating the socio-economic situation [ 10 ].

In Kelantan, the common practice of waste disposal in rural and remote areas is by burying and burning of waste (Kamaruddin et al. 2016) while in urban or semi-urban areas, stationary waste storage containers are provided mainly at the sides of the main road. Kota Bharu Municipal Council (KBMC) is the local authority responsible in providing stationary waste storage container at collection site of waste within Kota Bharu district, collecting the solid waste approximately 3 times a week by compactor vehicles and transporting waste to the dumpsite located in Beris Lalang, Bachok [ 27 ]. However, the flaws of SWM in Kelantan lies primarily in inadequate bin and waste collection provided by local authorities, KBMC mainly constrained by financial issues (Rahim et al 2012). House to house waste collection is also hard to be implemented owing to narrow lanes and alleys which are mostly inaccessible [ 61 ] due to the development practice and geographical area in the state. Therefore, the locals’ resort to burying and burning their wastes within their house compound which has always been the practice since decades ago.

Household waste is one of the primary sources of MSW comprising of food wastes, paper, plastic, rags, metal and glasses from residential areas. Household waste is among the solid wastes managed by KBMC in Kota Bharu covering 15 sub-districts including Panji. Panji has the highest population compared to the other sub-district; therefore, assessment of household SWM among the residents is important to address their awareness and practices for planning an effective form of SWM. Some of the key factors influencing the effectiveness of SWM is by considering the size of the family, their income [ 67 ], level of education [ 19 ] and the location of household [ 1 ]. This factor is also supported by Shigeru [ 66 ] that the characteristics of households determine their recycling behavior and that sociodemographic conditions vary across municipalities. Socio-economic status and housing characteristics also affect the amount of municipal waste and how they manage it [ 20 ]. Therefore, it is crucial to understand the characteristics and needs of various households in designing a suitable waste management program.

Efficient SWM system is now a global concern which requires a sustainable SWM primarily in the developing countries. This study is another effort in gearing towards sustainable waste management practices in Malaysia which is also in line with the United Nation Sustainable Development Goals encompassing SDG3 Good Health and Wellbeing and SDG 12 Responsible Consumption and Production. So far, limited studies were reported in the East Coast of Malaysia, particularly in Kelantan on waste management practices at the household level [ 61 ] which is highly required to improve the current practices including finding the prospect of whether proper at source-sorting in households is feasible to be implemented. This study provides a case study in Panji, Kota Bharu concerning the current household characteristics and awareness of managing household solid waste in Kelantan. The findings are crucial for the waste authorities in the process of designing and providing an effective and specific action plan in the area.

Figure 2 shows the percentage of households by garbage collection facilities and median monthly household income (MYR) for the districts in Kelantan. Kota Bharu is the district with the highest median monthly household gross income and percentage of garbage collection facilities. Apart from Lojing, which is located in the highlands, Bachok, Tumpat and Pasir Puteh are the districts with the lowest percentage of garbage collection facilities within 100m of the households. Meanwhile, Bachok (34.9%), Pasir Mas (36.6%), and Pasir Puteh (38%) households are without garbage collection facilities. The figure described the problem with household solid waste management in Kelantan. The major issues contributing to the problem are due to insufficient financial resources, lack of human labor, and transportation [ 61 ]. In one of the rural area in Kelantan, it was found that the solid waste management is considered inefficient due to a lack of knowledge in proper waste handling and the importance of segregating waste properly as proper waste handling start at home (Abas et al. 2020).

Percentage of households by garbage collection facilities and median monthly household income (MYR) for the districts in Kelantan

Household SWM is not a new issue, thus, published studies were found using survey and questionnaires and fieldwork studies. Waste characterization process was carried out by Kamaruddin et al. (2016) in 4 landfills in Kelantan. Nevertheless, they did not cover household waste knowledge, attitude and practices. Abdullah et al. [ 1 ] surveyed the household’s awareness on privatization of solid waste management and their satisfaction of the services offered but did not cover the health implications. Saat et al. [ 61 ] surveyed the practices and attitude on household waste management with a small sample size of less than 30 which limits its applicability to other region. Our study aimed to improve these previous studies by covering a wider sample size from the largest sub-district in Kelantan, Malaysia. The objective of this study is to assess the household SWM practices and perceptions among the residents of Panji vicinity in Kota Bharu district, Kelantan. Specifically, the objectives are to assess household SWM practices and perceptions in the Panji sub-district, to determine the association between socio-demographic characteristics or other factors and practices in SWM at the household level and to determine the association between socio-demographic characteristics or other factors and perceptions in SWM at household level.

This study was conducted in Panji, Kota Bharu district, Kelantan, Malaysia (Fig. 3 ), located at the east cost of Peninsular Malaysia and has the highest population among the 15 sub-districts of Kota Bharu, the capital state of Kelantan. A total of 338 respondents were recruited in this study. The population of interest in this study involved residents in Kota Bharu district and considered only residents who have attained 18 years old and above. Sample unit is residents living in Kota Bharu district of more than a year and aged more than 18 years. The target population comprised all the households in Kota Bharu District (491,237); however, it is impossible to conduct a study with such a large number within a limited time period and inadequate financial budget. Therefore, a multi- stage random sampling technique was used in selecting the appropriate sample in order to evaluate the objectives of this study and to ensure that households in the districts had the same possibility of being included in the study (Dlamini et al., 2017). Initially, one district of Kelantan state (Kota Bharu) was selected out of 10 total districts. In the second stage, one sub-district of Kota Bharu District (Panji) was selected out of 15 total sub-districts. Eventually, 338 households were randomly selected as sample size. Convenient sampling was also used to select respondents due to time constraint and response obtained from target population. The localities involved were Kampung Tapang, Kampung Chempaka, Kampung Belukar, Kampung Panji, Taman Sri Iman, Taman Desa Kujid and Taman Bendahara.

Location of the study area in Panji, Kota Bharu district, Kelantan, Malaysia (Source:ArcGis Software version 10.2; source of shape file: Department of Drainage and Irrigation, obtained with consent)

Data collection

A survey was conducted from January to May 2018. The questionnaire was translated from English to Malay language and the translation was done back to back and validated by experts in environmental science and public health field. A pilot test was conducted with a small sample size of ~30 to determine the suitability of the items in the questionnaire and the time taken by respondents to complete the questionnaires (Dlamini et al. 2017). Respondents were interviewed based on a questionnaire adopted and modified from Asante et al. [ 9 ]. The questionnaire involved two phases; the first one was to determine the socio-demographic of the respondents, including gender, age, types of housing, religion, educational level, occupation and the number of occupants in the household. Part two was an assessment to determine the status of household management of solid waste. The questionnaire included both open and closed questions (Dlamini et al. 2017). The closed questions were designed for ease of answering by the respondents with the aim of collecting the maximum appropriate responses, whereas the open questions are intended to encourage respondents to provide further elaboration on certain questions. The reliability of Cronbach’s alpha test of this questionnaire was found to be acceptable (α=0.71). Ethical approval for this study was obtained from the Ethic Committee of Universiti Sains Malaysia (USM/JEPeM/17100560).

Data analysis

Data were analyzed using IBM Statistical Package for Social Science (SPSS) version 24.0. Descriptive analyses were used to report the frequency and percentage of socio-demographic patterns, method of household waste disposal and perceptions of household toward waste management. Chi-square goodness of fit test was used to determine the relationships between categorical variables, which allow us to test whether the observed proportions for a categorical variable differ from the hypothesized proportions [ 24 ]. The null hypothesis of the Chi-Square test is that no relationship exists on the categorical variables in the population; they are independent. Chi-square bivariate correlation test was performed to observe the correlation between the perceptions of waste segregation with socio-demographic background of the respondents [ 29 ]. The correlation between perception of respondents with the locality, house type and waste type were also conducted. Principal component analysis (PCA) was conducted to identify grouping of variables and to establish which factors were interrelated in any given construct, where a set of highly inter-correlated measured variables were grouped into distinct factors [ 24 ]. The Kaiser-Meyer-Olkim (KMO) Measure of Sampling Adequacy and Bartlett's Test of Sphericity was performed to evaluate the data's suitability for exploratory factor analysis [ 69 ].

Socio-demographic Characteristics and Respondents Background in Panji sub-district

We first report descriptive statistics for all variables before discussing results from correlation analysis of socio-demographic factors and respondent’s background with household solid waste management (SWM) practices and perceptions. We then present the Principal Component Analysis (PCA). Table 1 represents the socio-demographic background and characteristics of the respondents in this study. Most of the respondents are from Kg. Belukar (N=125, 37%), followed by Kg. Panji (N=61, 18%), the rest are from Kg. Tapang (N=33), Kg. Chempaka, Taman Desa Kujid, Taman Sri Iman (N=30, respectively) and from Taman Bendahara (N=29). Majority of the respondents are female (N=182, 53.8%) and age between 35 to 49 years old (N=91, 26.9%). Most of the respondents have completed secondary education (N=194, 57.4%) and 31.1% have completed their degree or diploma (N=105). Majority of the respondents are married (75.7%), Muslim (97%) and earned between MYR 1000 to 2000 per month. About 32% of the respondents are self-employed and lived in a bungalow house type (30.5%). Most of the household consist of 4 to 6 occupants (53.6%). Majority of them cook at home (91.4%) on daily basis (68.6%). The Chi-square test shows that there is a significant difference among all categorical variables except for gender (χ 2 = 2.000, p = 0.157).

Proportion of Household Solid Waste Disposed by respondents in Panji Sub-District

Figure 4 represents the type of waste disposed of by respondents in the study. More than half (74.38%) of the waste disposed by household is food debris, followed by plastic waste (19.01%) and bottles (5.79%) while the rest accounts for 0.83%.

Types of waste disposed by household in Panji district

Household SWM practices and perceptions among respondents in Panji sub-district

Table 2 shows the household waste management practices and perceptions among respondents in Panji district. In terms of the household SWM practices, about 170 of the respondents (50.3%) segregate their waste at home while the remaining 168 respondents (49.7%) did not practice waste segregation at home. There is no significant difference between those who segregate waste at home and those who don’t (χ 2 =0.12, p=0.91). As shown in Fig. 1 and Table 2 , the major type of waste disposed by respondents are food (N=251, 74.3%). A significant difference was found among the different type of waste disposed (χ 2 =656.56, p<0.001). Out of the 338 respondents interviewed, 75.4% of the respondent themselves normally carries their household waste to the allocated bin or waste collection point provided by the local authority. Majority of the respondents (323 respondents) agree that the waste disposal site provided by the local authorities were appropriate (95.6%) relative to 15 respondents who disagree (4.4%). A significant difference was found between those who responded that appropriate waste disposal site was provided and those who do not (χ2=280.66, p<0.001).

Most of them also have the perception that proper waste management is important (99.7%). More than half (62.4%) of the respondent agrees that it is their responsibility to clean the waste in their residential area while 24.3% suggested that it is the responsibility of the district council. Another 3.3% suggested it is the responsibility of the community members followed by private waste operators (1.5%). The majority (95.9%) of the respondents suggested poor waste management can contribute to disease occurrence, whereas 2.7% suggested it does not cause diseases and another 1.5% were unsure if it causes any diseases.

In terms of the household SWM perceptions, 40.8% of the respondents have responded that other diseases than diarrhea, malaria and typhoid are related to improper waste management. This is followed by diarrhea (30.5%) and malaria (21.9%). Majority of the participants responded that they have awareness on proper waste management (92.9%) and 81.4% responded that cleanliness is the main factor which motivates them to dispose the waste properly. The chi-square test shows that all variables under respondents’ perception differ significantly from the hypothesized values (Table 2 ).

Relationship between socio-demographic characteristics, respondent’s background and household SWM practices (waste segregation practices)

Chi square analysis was performed to find out what factors contribute to waste segregation practices among the respondents (Table 3 ). Results indicate that waste segregation practice was correlated with the locality (χ 2 = 43.35, p<0.001). For instance, out of 29 respondents in Taman Bendahara, all of them segregate their waste (100%). This trend was also observed for Taman Desa Kujid where most of the respondents segregate their waste (22 out of 30, 73.3%). In contrast, most of respondents from the village, did not segregate their waste. For example, out of 125 total number of respondents in Kg Belukar, 53 of them segregates their waste (42.4%) while 72 of them did not (57.6%).

A significant correlation was found between waste segregation practice and age (χ 2 =11.62, p<0.001). Based on the age range of the total number of respondents, respondents at the age of 50-65 years old are those who segregated more than the rest (N=43) and those at the age of 35-49 are those who did not segregate their waste the most (N=52 in Table 3 ). The type of house was significantly correlated with waste segregation practice (χ 2 =12.73, p=0.03). The respondents who live in bungalow houses are those who segregate the most (N=58). Those who live in semi-detached houses also have more respondents (N=24) segregating their waste than those who did not (N=13). Meanwhile those who live in other type of houses, terrace, village and others have more respondents who did not segregate their waste (Table 3 ). Other variables, gender, education level, marital status, monthly income, occupation, the number of persons per household and the practice of cooking at home did not show any significant correlation with waste segregation practice (p>0.05, Table 3 ).

Relationship between respondent’s background and household SWM practices (the type of waste disposed) from the household in Panji sub-district

The chi-square test was also conducted to determine the relationship between socio-demographic characteristics, respondent’s background and the type of waste disposed. There is a significant correlation between locality with the waste type disposed in Panji district (Table 4 ). All localities showed that food waste was the major type of waste being disposed of from the households. A significant correlation was also found between respondents living in different house types with type of waste disposed. Most of the respondents who live in bungalows (N = 81) and other type of house (N = 78) disposed of food as the main waste from their households. Other characteristics were not significantly correlated with type of waste.

Correlation between respondents’ background (locality and/ or house type) and the perception in household SWM (appropriate site of household waste disposal provided by the local council and improper waste management contribute to disease occurrence)

Correlation analysis was also performed to determine what factors contribute towards the perception of household SWM in Panji district. No significant correlation was found between different locality with the appropriate waste disposal site provided (p = 0.152) as most of the locality has an appropriate disposal site (Table 5 ). There was also no significant relationship between type of house with appropriate disposal site provided by the local council (p=0.131). On the other hand, significant correlation was found between locality and the respondent’s perceptions on improper waste management which contribute to disease occurrence (p=0.042). Out of all localities, majority of the respondents from Kg Belukar has the perception that improper waste management contributes to disease occurrence (Table 5 ).

Principal component analysis (PCA)

Principal Component Analysis (PCA) is a dimension-reduction tool that can be used to reduce a large set of variables to a small set that still contains most of the information in the original large set [ 24 ]. It converts a set of observations of possibly correlated variables (entities each of which takes on various numerical values) into a set of values of linearly uncorrelated variables called principal components [ 37 ]. This transformation is defined in such a way that the first principal component has the largest possible variance (that is, accounts for as much of the variability in the data as possible), and each succeeding component in turn has the highest variance possible under the constraint that it is orthogonal to the preceding components.

PCA in this study was performed to determine the variables that influence or related to waste segregation behavior among respondents. Table 6 highlight the PCA analysis to illustrate the component factors that influence waste segregation behavior among respondents in this study. Only 13 significant variables were highlighted in the table with the factor loading of more than 0.5. Only factor loadings value >0.5 are considered for selection and interpretation due to having significant factor loadings influence the acceptable KMO value that represent a significant correlation for the PCA model in the study. The PCA generates four principal components that represent 48.26% of the total variance in the variables dataset and produced an acceptable KMO value of 0.603 (more than 0.5). Bartlett’s test of sphericity showed that PCA could be applied to the data at the p< 0.001 level. This approved that the data met the requirements for factor analysis [ 24 , 69 ].

The component matrix produced in PCA showed that PC1 represents 17.94% of the variance with high positive loading (positive relationship) on age, marital status and, type of house (Table 6 ). This pattern indicates that age, married and type of house were the group that segregates their waste the most. This group of community can be proposed as the target to actively participate in waste management practices within the district. In contrast, locality and education have negative loading or negative relationship with the segregation activity. As a result, policy makers should increase educational activities on proper household waste practices and management related issues to minimize both the environmental and health impacts of household waste practices among the population.

PC2 represents 10.93% of the variance with high loadings on cooking at home and cooking frequency. This pattern implies that those who cook at home and frequently cook were among the most respondents who practice waste segregation. However, no consequences can be drawn about individual factors as these may have the opposite relationship to the observed factor in other components. Similar trend was observed for PC3 whereby 9.96% of the data variance has high loading on the perception of the respondents towards waste management. High loading was observed on perception that improper waste management contributes to disease occurrence and the cleanliness is the main element that motivates them to segregate. PC3 has high negative loading with monthly income. This result suggests that respondents with low income are those who segregate more.

Meanwhile, PC4 represents 9.42% of the data variance. Variables that have high positive loadings were the respondents who brought the waste to the communal bin themselves, indicating that this group of respondents are those who segregate more. High positive loading was also found on the perception that residents are among those responsible for cleaning the residential area. The number of persons living in a household has negative loading in PC4, indicating that the higher the number of people lives in the household, the lesser chances of them to segregate the waste.

Extraction Method: Principal Component Analysis.

a 4 components extracted.

b Only cases for which Practice of waste segregation = Yes are used in the analysis phase.

This study explores the behavioral perspective in view that the way people manage waste is associated with their attitude and perception. Individual perception is governed by their background and present situation, shaped by values, moods, socials circumstances and individual expectation (Kaoje et al 2017). The results of this study are discussed from three aspects: (1) characterization of household solid waste management practices and perceptions among respondents (2) correlation between socioeconomic and respondent’s background with waste segregation practices and (3) correlation between socioeconomic and respondent’s background with household waste management perceptions. One of the primary intentions of acquiring the respondent’s characteristics was to understand the correlation between level of involvement in household SWM practices and the characteristics of the respondents.

Food waste was found as the major type of waste disposed by the communities in Panji sub-district (Fig. 1 and Table 2 ). Food waste has high moisture content and causes smell, which subsequently attracts disease vectors, such as flies, mosquitoes and cockroaches, and the proliferation of rodents, such as rats and mice, which pose threats to public health [ 68 , 75 ]. Majority of the respondents were found to cook at home (N=309, 91.4%) and cook on a daily basis (N=232, 68.6%; Table 1 ) which suggests that composting should be incorporated as one of the main approaches for proper waste management practices in the community. Individual compost bin should be provided in each household coupled with adequate training on simple compost technique can be organized within the locality as a stage by stage process. Alternatively, community scale composting can be proposed to focus solely on food waste management which is currently a growing practice among Malaysians [ 38 , 56 ]. This approach is gaining attention because of their lower energy footprint, ease of operation, need for lesser resources, lower operation and maintenance costs which have higher chances of public acceptance [ 32 ]. Food waste is organic waste which can decomposed and degraded into organic matter [ 33 ], which in turn can be used by the public to fertilize their garden soil. Most importantly, the training should emphasize on the practicality and feasible option of composting which is otherwise seen as a time-consuming and burdensome process [ 33 ].

Composting is beneficial to the environment by reducing greenhouse gases emissions and improvement of soil quality when applied to land. Furthermore, it is also in line with the circular economy concept by closing the loop of the system [ 14 ]. On the other hand, there are issues pertaining to its quality such as the nutrient and trace metal content. So, sorting the waste at source play a crucial role in minimising these impurities and collection systems play a fundamental role in removing some pollutants from wastes, especially organic fraction of municipal solid wastes, and improving compost quality [ 13 ]. One way to overcome this is by accommodating the waste collection and composting facilities with easy and convenient measurement of these contents which may be accessible by the community. Community composting programs should incorporate not only the step-by-step procedure of how to do composting but at the same time introducing easy to use kit or techniques applicable to the public and community such as test strip to measure the nutrients and trace metal [ 11 ]. In addition, by adding composting accelerators, the nutritional quality of the compost can be overcome. This factor can be done by developing a manual for public use.

The case of local composting at homes reduces transportation and collection cost by decreasing the amount of domestic waste carried to centralized composting facilities [ 76 ]. At the same time, household waste contains impurities and are widely distributed which hinders the efficiency of centralized composting facilities in disposing them. Centralized composting facilities in Asia suffer from low compost quality and poor sales [ 32 ]. As a result, community composting system at a smaller scale is more convenient within this region.

Composting is linked to diseases such as Aspergillosis, Legionnaire’s disease, histoplasmosis, paronychia and tetanus. In the case of Aspergillosis and Legionnaire’s disease, it may cause higher potential risk in large scale composting facilities compared to the smaller scale composting at home due to massive handling and agitating process in the former [ 26 , 59 ]. Histoplasmosis have been associated with chicken manure used in composting, however it is not able to survive in a well-done composting process [ 39 ]. Therefore, disease spread can be minimised by having local composting at homes and community composting system at a smaller scale than centralized composting facility. The most important thing in minimising disease spread would be the practise of wearing gloves and face mask during this composting activity.

In this study, there was not much difference between the respondents who separated their waste and who did not (Table 2 ), which implies there is room for increasing the practice of waste segregation. Waste segregation practice is lacking in developing countries, most prominently in Asia ( [ 15 , 48 ]; Vassanadumrongdee and Kittipongvises 2018) and African continents (Dlamini et al. 2017; Yoada et al. 2014). Since respondents lack adequate knowledge on the critical importance of waste separation at source in general, the volume of municipal solid waste dumped in landfill sites are progressively increasing, thus jeopardizing the remaining landfill space at a faster rate than initially planned. Therefore, to alleviate this environmental problem in the developing countries in general and in Panji sub-districts, specifically, more focused and sustained public awareness programs, integrated with an enabling infrastructure, are required to change residents’ perceptions toward improved waste separation at source rates [ 49 ]. Additionally, the outcome of the waste segregation activities should be similarly emphasized and how waste minimization in the first instance, and waste segregation at source, will benefit and enhance the standard of living or life quality of households ([ 44 ]; Yoada et al. 2014 [ 49 ];).

The perceptions of the respondents towards waste management were generally good. About 99.7% reported that waste management is important, 62.4% report that it is the responsibility of them to manage waste (Table 2 ). Resident’s participation in waste management activities is one of the ways in maximizing the capture of source-segregated materials which can be facilitated by providing an associated infrastructure [ 58 ]. Nevertheless, there are still some respondents who felt that waste management is not their responsibility, but instead lies mainly on the district council, which highlights the general perception of some Malaysians that waste is a local municipal issue [ 46 ]. About 95.9% of the respondents were aware that improper waste management leads to sicknesses or diseases, which implies that most of the households were aware of the health implication of waste. The management of MSW in developing Asian countries is driven by a public health perspective: the collection and disposal of waste in order to avoid the spread of disease vectors from uncollected waste [ 5 ]. The perception of the remaining 2.7% that waste management does not cause disease and 1.5% who were unsure need to be changed by targeting this group as a follow up program focusing on waste management and health issues. The respondents also have adequate level of awareness and knowledge about proper waste management (92.9%). This high level of awareness is because of several reasons for properly disposing of waste, including cleanliness as the major factor (81.4%), followed by fear of illnesses (12.4%), and odor (6.2%).

Most of the respondents thought that improper waste management could lead to diarrhea and malaria (Table 2 ). Diarrhea and waste management is associated with environmental factors such as waste disposal mechanism. House-to-house waste collection has been shown to decrease the incidence of malaria compared to other waste collection method [ 7 ]. Hence, this implies the possibility of malaria incidence in areas which burn their waste and areas which are inaccessible by any waste collection. Other diseases could be related to typhoid, dysentery, cholera, respiratory infections and injury [ 42 ]. Proper waste management can lead to improvement in the quality of the environment and public health while, mismanagement of waste can be implicated with water, soil and air pollutions [ 1 ], breeding of mosquitos, which in turn, causes disease [ 15 , 68 ]. Although knowledge and awareness are acceptable among the respondents, this perception did not inculcate into waste segregation practices. In order to bridge the gap between awareness and behavior change, it is necessary for individuals to understand the importance of their role in how to do it and why it is important to do so [ 34 ]. More focused, detailed and continuous awareness and knowledge should be emphasized on this aspect specifically in the topics of environmental cleanliness, drainage systems, the recycling process in theory and practice, and a proper way to dispose of wastes [ 61 ].

Our findings have reported that socio-demographic factors (age, marital status) and respondents’ background (locality and house types) have influenced the household waste practices and perceptions in Panji sub-district (Tables 3 , 4 , 5 and 6 ). Age is associated with the maturity of the person which plays a significant factor in impacting their level of awareness on environmental health and sanitation ([ 12 , 17 ]; Meneses and [ 40 , 45 ]). The result of our study is consistent with the findings by Fan et al. [ 22 ] that older individuals prefer to engage more in waste sorting activities than young people in Singapore.

On the other hand, the number of children in the household may be a significant factor that influence waste separation. This for instance has been mentioned in Xu et al., (2017), where the intention of middle-aged adults towards behaving a more eco-friendly system was affected by critical social reference groups around them, such as the interaction with family or the motivation, especially children, and/or the consideration of the health situation of the whole family.

However, in other studies such as in Ittiravivongs [ 28 ] and Vassanadumrongdee & Kittipongvises (2018), socio-demographic variables became insignificant factors that influenced waste segregation participation. Knussen et al., [ 36 ] & White & Hyde [ 73 ] also indicate that the strongest variable influence participation in waste segregation program was past behaviour on regular source separation at home or recycling habit. Having waste separation in the office also could have positive influence on source separation intention, which is consistent with the study of Saphores et al. [ 64 ].

Considering number of children in the analysis is beyond the scope of this paper. Our result indicates that there is no significant difference in the waste segregation practice by the number of occupants in the household (χ 2 = 2.36, p = 0.31). For instance, the results show 54.2% of household with more than 6 occupants practice waste segregation, as compared to those who are not at 45.8%. This would suggest that the number of children in the house could be less influence on the waste segregation practice or vice versa. Future study may consider number of children in the family as one of the variables to be tested to confirm the hypothesis.

It was interesting to note that the types of housing in the case study were found to contribute heavily to the practices and perceptions of household waste management. Respondents who lived in bungalows (30.5%) and other type of houses than semi-detached, terrace and village (28.4%) are most likely to segregate their waste. Bungalows are associated with high income areas in Malaysia [ 53 ], which could be related to waste collection services are provided from these areas and possibly these households subscribe to this service. Potentially, these types of houses also have more space to be allocated for waste sorting than the other type of houses.

Other socio-demographic characteristics such as gender, education level and monthly income did not influence the practices and perceptions of the respondents. There were no significant associations between gender and waste segregation practices (χ 2 =0.596, p=0.440). Our finding is contrasting to the study by Ehrampoush and Moghadam [ 18 ] which reported that gender is likely to have an influence on the perceptions of household SWM. This view is supported by Mukherji et al. [ 48 ] who found that women, because of traditional gender roles associated with their household activities, have a closer engagement with waste management at household level.

The level of education has been reported as an important factor that could influence people’s perception of household waste management [ 40 ]. In this study, most of the respondents received their education until secondary school (57.4%), followed by diploma or degree (31.1%) but this did not influence their household SWM practices and perception (χ 2 =6.188, p=0.19), in particular waste segregation practice (Table 3 ). The poor average income of respondents is considered a very important variable that could influence people’s perception and attitudes negatively on solid waste management system (Parfitt et al. 1994 [ 40 ];). But, this is not the case in our study as economic consideration appears not to play a major role in the respondent’s perception as well as attitude to solid waste management practices (χ 2 =4.55, p=0.47).

The outcome from the PCA analysis showed that age, marital status and type of housing are the factors which contributed the most to waste segregation practices at home. Our finding agrees with the study by Vassanadumrongdee and Kittipongvises (2018) which found that age and family with children have a positive influence on respondent's source separation. Age was also a determinant factor in waste management practices in other studies [ 2 , 15 ]. With aging and married respondents, this could be highly related to the increasing sense of responsibility towards the environment and the importance of increasing the quality of life among household members. Types of housing could be related to either waste collection services were provided in these areas or that limited number of households subscribe to their service. Other studies in the literature have reported on the positive relationship between residence types and waste separation practices ([ 15 ]; Vassanadumrongdee and Kittipongvises 2018).

The high loadings on cooking at home and cooking frequency towards waste segregation practices indicate that these groups of respondents can be chosen for further interventions in terms of adopting proper waste management practices such as small-scale composting, recycling and waste minimization practices. The lifestyle of the respondents plays a significant role in the daily waste disposal practices in households (Yoada et al. 2014 [ 15 ];). The link between improper waste management practice and disease occurrence was also reported in studies in Ghana (Yoada et al. 2014 [ 2 ];). Their studies also reported that cleanliness was the main factor which motivates them to segregate the waste which is concurrent with the findings in this study.

Education is negatively related to waste segregation activity (Table 6 ), indicating that people with lower education are more willing to segregate their waste as compared to those with higher education. The likely reasons could be related to different lifestyle and time constraint to allocate purposely for waste sorting activities [ 15 ]. People with higher education level may be spending most of their time at the workplace, and not at home. However, more educational campaign should be promoted by emphasizing on the benefits of waste segregation activities. Sufficient knowledge, such as clear instructions provided in a communication and collection campaign, can increase the probability of waste separation behavior (Vassanadumrongdee and Kittipongvises S 2018).

The higher number of occupants living in the household is associated with a less likely chance of segregating the waste (Table 6 ). The result of our study is consistent with the study by Addo et al. [ 2 ] which reported that household sizes of 4 to 6 and above 7 were less likely to engage in the practice of waste management as compared to household size below 4 people. This is probably due to the household size tends to reduce the quantity of household waste and the practice of waste management. In contrast, studies by Osbjer et al. [ 54 ], indicate that waste management practice is associated with a higher number of people in the households, which could possibly be due to the need to handle waste generated by larger populations within the household.

One of the objectives of this study was to determine variables that influence waste segregation behavior among respondents. The PCA was adapted for this objective rather than correlation analysis for several reason. The correlation coefficient assumes a linear association where any linear transformation of variables will not affect the correlation. However, variables X and Y may also have a non-linear association, which could still yield a low correlation coefficient [ 30 ]. In addition, the correlation coefficient cannot be interpreted as causal.

It is possible that there is a causal effect of one variable on the other, but there may also be other possible explanations that the correlation coefficient does not take into account. Since several variables may influence respondent’s behavior on waste segregation activity at one time, the correlation coefficient analysis may not adequate to identify the significant variables and the connectivity between them accurately. Therefore, PCA was used to help us understand the connection between these variables as it can identify the correlation among the features efficiently.

There are thousands of features in the dataset that possible to highlight some trend or the influence of one factor to another. There are challenges to visualize the algorithm on all features efficiently especially when the performance of the algorithm may reduce with the bigger dataset. The PCA improve the algorithm performance by getting rid of correlated variables which don't contribute to the model and the analysis of the algorithms reduces significantly with less number of features. The Principal Components are also independent of one another. There is no correlation among them. It also reduces overfitting by reducing the number of features where it mainly occurs when there are too many variables in the dataset.

The scenario of the covid-19 pandemic contributes to a significant challenge in managing household waste management globally and specifically in developing countries. Waste management in the pandemic scenario requires consideration in SARS-CoV-2 transmission through MSW handling that includes survival time of the virus on the surfaces: population density and socioeconomic conditions [ 35 ]. In general, waste management phases (waste packing and delivering by the users; waste withdrawal; waste transport; and waste treatment) exposed the community and workers to direct contact with contaminated objects and surfaces; as well as contact with airborne droplets at a distance that may lead to the covid-19 [ 16 ]. Due to these reasons, waste management practices are designed to respond to the pandemic through changes in the collection system, allocation of treatment options, safety measure and priority separation, and functionality of circular economy strategies [ 72 ].

As a developing country, it is predicted that the effect of covid-19 on the waste management practices are more crucial due to the increase in disposable personal protective equipment at the household level and changes in eating habits, as a consequence of lifestyle disruptions and psychological stress due to lockdowns [ 4 , 55 ]. Developing countries have a higher risk of waste and wastewater contamination, leading to significant public health issues [ 71 ]. Inefficient waste management practices such as insecure landfills, lack of technical knowledge, scientific and economic resources, and lack of waste emergency policies produce severe consequences to the community and workers [ 63 , 65 , 71 ].

In order to improve the level of household solid waste management in the study area and Malaysia in general, it is important to empower the key drivers. The key drivers can be categorized as institutional-administrative, technological, economical, and social drivers [ 70 ]. A strong policy that implements direct regulation and enforcement; provide economic incentives or disincentives; and inform, interact and engage with the community are required [ 60 ].

Household solid waste management technologies that are being practised globally are landfilling, incineration, pyrolysis, Refuse Derived Fuel (RDF), gasification, and anaerobic digestion [ 57 ]. As a developing country that focuses on solid waste management through landfilling, it is important to put extra attention on: i. decentralization of household solid waste management; ii. segregation at the source; iii. hygienic and safe handling; iv. flammable landfilll gasses handling; v. soil salinity from compost application; vi. Sustainable landfill management; vii. alternative markets for energy products; and viii. Implementation of the “pay as you throw” system [ 50 ].

Practical Implications, Study Limitations and Future Perspectives

This study highlights that waste segregation practice among respondents are still low and food waste are mixed with other household waste. This study provides as a baseline data in the region where less study was emphasized.

Quantitative and qualitative approach were used in this study by adopting descriptive and statistical analysis to improve the significance of the issue. Despite the significance of some aspects of this study, further studies should be done to incorporate children and teenagers as the participants and a more detailed questionnaire incorporating detailed health implications. Apart from that, a cross-sectional survey using random sampling technique was used to assess the household SWM practices and perceptions among the residents. This study is also limited to only Panji sub-districts which requires a wider region to generalize the findings of the study. The survey questionnaires depend on self-reporting manner, which may be subject to bias. Further study is recommended to engage observation at houses or at the waste collecting points to complement the survey. Moreover, the association between household socio-economic factors and health implications were limited. Future study should address this factor for a more focused and sustained public awareness programs.

Conclusions

The study found that the waste segregation practice among respondents can be considered as low, where the number of respondents who segregate their waste was equivalent to those who did not, which implies there is room for improvement. The main component of solid waste generated at home was largely food debris that has the potential to be composted and plastics that can be recycled, which were mainly disposed without separation. The local solid waste management authority should focus on utilizing this organic waste through a larger scale and wider involvement of the locals in composting program. The growth of small-scale community-based waste composting can act as a potential start up venue in accelerating this program, without the necessity of extensive investment by the local authority. The authority in the study area has provided appropriate waste disposal sites, but there are also some that were disposed in inappropriate sites. Majority of the respondents were also aware that improper waste management can lead to diseases. Age, marital status and, type of house was found to be the group that segregate their waste the most, indicating that respondents which fall under this category can be the target for further intervention programs. This study suggests the local authorities to design waste separation programs that suit the needs of targeted population, to ensure high participation rate among the community. Marketing and campaigns should emphasize the positive perception and attitude towards waste separation at home and also negative perception of non-participants. This study may provide authorities in Malaysia with baseline information to set the future implementations of waste segregation activities in households. This study also suggests focusing on inculcating community involvement in doing waste separation at source, waste reduction and recycling as a habit and way of life. The local authority may facilitate this activity by providing bins to segregate wastes, establishing waste banks and recycling facilities at a wider scale than the scattered existing ones. Both a top-down and bottom-up approach should work hand in-hand to realize the sustainable solid waste management as a success.

Nevertheless, acknowledging the limitations of the current study, a more detailed and thorough study should incorporate a wider region, in-depth association of waste separation programs and health implications. Combining survey questionnaire with statistical analysis act as a stepping stone to expand the study by engaging the community in actual waste separation activities. This can be done by initiating a collaboration between the local authority, the leader in a community and the residents itself as a pilot study. In addition, the findings of this study will serve as baseline evidence and pave the way for other researchers and policymakers to conduct more rigorous studies on this arena.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the supplementary material section.

Abbreviations

Statistical Package for Social Science

Solid Waste Management

municipal solid waste

not in my backyard

Kota Bharu Municipal Council

Sustainable Development Goals

Malaysian Ringgit

Principal component analysis

Kaiser-Meyer-Olkim

Refuse Derived Fuel

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Acknowledgments

We are grateful to everybody who completed the questionnaires and to Miss Aisyah Ariff, Miss Zetty Hiddayah binti Zuharizam and Mr Wan Izulfikri bin Wan Mohd Roslan for assisting in data collection.

This study was financially supported by Ministry of Higher Education Malaysia (Postdoctoral Fellowship SLAB) and Universiti Sains Malaysia. None of the funders were involved in the design of the study, in the collection, analysis, and interpretation of data and in the writing of the manuscript.

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Widad Fadhullah, Nor Iffah Najwa Imran & Hasmah Abdullah

School of Industrial Technology, Universiti Sains Malaysia, USM, 11800, Penang, Malaysia

Widad Fadhullah & Mohd Hafiidz Jaafar

Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia

Sharifah Norkhadijah Syed Ismail

Biomedicine Program, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia

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WF contributed in conceptualization and writing the manuscript. NINI collected the data, contributed to the literature review and execute the project. SNSI contributed in the formal analysis, methodology, data curation and the tables and figures. MHJ contributed to editing of the manuscript. HA contributed in supervision, project administration and planning. All authors have read and approved the final version of this manuscript.

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Fadhullah, W., Imran, N.I.N., Ismail, S.N.S. et al. Household solid waste management practices and perceptions among residents in the East Coast of Malaysia. BMC Public Health 22 , 1 (2022). https://doi.org/10.1186/s12889-021-12274-7

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Biomedical Waste Management and Its Importance: A Systematic Review

Himani s bansod.

1 Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND

Prasad Deshmukh

2 Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND

The waste generated in various hospitals and healthcare facilities, including the waste of industries, can be grouped under biomedical waste (BMW). The constituents of this type of waste are various infectious and hazardous materials. This waste is then identified, segregated, and treated scientifically. There is an inevitable need for healthcare professionals to have adequate knowledge and a proper attitude towards BMW and its management. BMW generated can either be solid or liquid waste comprising infectious or potentially infectious materials, such as medical, research, or laboratory waste. There is a high possibility that inappropriate management of BMW can cause infections to healthcare workers, the patients visiting the facilities, and the surrounding environment and community. BMW can also be classified into general, pathological, radioactive, chemical, infectious, sharps, pharmaceuticals, or pressurized wastes. India has well-established rules for the proper handling and management of BMW. Biomedical Waste Management Rules, 2016 (BMWM Rules, 2016) specify that every healthcare facility shall take all necessary steps to ensure that BMW is handled without any adverse effect on human and environmental health. This document contains six schedules, including the category of BMW, the color coding and type of containers, and labels for BMW containers or bags, which should be non-washable and visible. A label for the transportation of BMW containers, the standard for treatment and disposal, and the schedule for waste treatment facilities such as incinerators and autoclaves are included in the schedule. The new rules established in India are meant to improve the segregation, transportation, disposal methods, and treatment of BMW. This proper management is intended to decrease environmental pollution because, if not managed properly, BMW can cause air, water, and land pollution. Collective teamwork with committed government support in finance and infrastructure development is a very important requirement for the effective disposal of BMW. Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve a goal of a green and clean environment. The aim of this review article is to provide systematic evidence-based information along with a comprehensive study of BMW in an organized manner.

Introduction and background

The amount of daily biomedical waste (BMW) produced in India is enormous [ 1 ]. People from all segments of society, regardless of age, sex, ethnicity, or religion, visit hospitals, which results in the production of BMW, which is becoming increasingly copious and heterogeneous [ 2 ]. BMW produced in India is about 1.5-2 kg/bed/day [ 3 ]. BMW include anatomical waste, sharps, laboratory waste, and others and, if not carefully segregated, can be fatal. Additionally, inappropriate segregation of dirty plastic, a cytotoxic and recyclable material, might harm our ecosystem [ 4 ]. Earlier, BMW was not considered a threat to humans and the environment. In the 1980s and 1990s, fears about contact with infectious microorganisms such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) prompted people to consider the potential risks of BMW [ 5 ]. BMW is hazardous in nature as it consists of potential viruses or other disease-causing microbial particles; it may be present in human samples, blood bags, needles, cotton swabs, dressing material, beddings, and others. Therefore, the mismanagement of BMW is a community health problem. The general public must also take specific actions to mitigate the rising environmental degradation brought on by negligent BMW management. On July 20, 1998, BMW (Management and Handling) Rules were framed. On March 28, 2016, under the Environment (Protection) Act, 1986, the Ministry of Environment and Forest (MoEF) implemented the new BMW Rules (2016) and replaced the earlier one (1988). BMW produced goes through a new protocol or approach that helps in its appropriate management in terms of its characterization, quantification, segregation, storage, transport, and treatment.

According to Chapter 2 of the Medical Waste Management and Processing Rules, 2016, “The BMW could not be mixed with other wastes at any stage while producing inside hospitals, while collecting from hospitals, while transporting, and should be processed separately based on classification.” The COVID-19 pandemic has now transformed healthy societies worldwide into diseased ones, resulting in a very high number of deaths. It also created one significant problem: improper handling of the medical waste produced in the testing and treatment of the disease [ 6 ]. In India, BMW generated due to COVID-19 contributed to about 126 tonnes per day out of the 710 tonnes of waste produced daily [ 7 ]. 

The basic principle of the management of BMW is Reduce, Reuse, and Recycle-the 3Rs. Out of the total amount of BMW generated, 85% is general (non-hazardous) waste, and the remaining 15% is hazardous. As BMW contains sharps and syringes, the pathogens can enter the human body through cuts, abrasions, puncture wounds, and other ways. There might also be chances of ingestion and inhalation of BMW, which can lead to infections. Some examples of infections are Salmonella, Shigella, Mycobacterium tuberculosis, Streptococcus pneumonia, acquired immunodeficiency syndrome (AIDS), hepatitis A, B, and C, and helminthic infections [ 8 ]. This systematic review is conducted to obtain essential, up-to-date information on BMW for the practical application of its management. The highlight of the management of BMW is that the “success of BMW management depends on segregation at the point of generation” [ 9 ].

The findings have been reported following the principles and criteria of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The systematic review has been conducted according to these standards and principles.

Search Sources/Search Strategy

We used the MeSH strategy to obtain articles from PubMed and ResearchGate employing the following terms: (“Biomedical/waste” [Majr] OR “Biomedical Waste/source” [Majr] OR “Biomedical Waste/hazards” [Majr] OR “Biomedical Waste/segregation” [Majr] OR “Biomedical Waste/rules” [Majr] OR “Biomedical Waste/laws” [Majr] OR “Biomedical Waste/environment” [Majr]). Specifically, for management-related studies, the search terms (“Management/steps” [Majr] OR “Management/handling” [Majr] OR “Management/coding” [Majr] OR “Color coding/segregation” [Majr] OR “Treatment/method” [Majr] OR “Autoclaving/waste” [Majr] OR “Incineration/waste” [Majr]) were used. We obtained the most pertinent research papers and used them in different arrangements using the Boolean operators “AND” and “OR.”

Inclusion and exclusion criteria

We focused on papers written in the English language, published within the last decade, relevant to the central questions of this review article, and that are systematic reviews such as randomized clinical trials and observational studies. We, however, excluded papers published in languages other than English, irrelevant to the questions, and related to topics other than BMW.

Search outcomes

After the initial screening, we narrowed the search results down to 264 papers. A total of 42 duplicate papers were removed. Subsequently, publications were refined by the title/abstract, and we eliminated a few studies due to the lack of full text and/or related articles. Finally, after assessing 27 items for eligibility, we included 11 papers in our review. Figure ​ Figure1 1 is the flow chart for article selection formulated on PRISMA.

PRISMA: Preferred Reporting Items for Systematic Review and Meta-analysis, PMC: PubMed Central

Need for BMW management in hospitals

BMW threatens the health of medical staff, hospital-visiting patients, and people in the nearby community. Improper disposal leads to severe hospital-acquired diseases along with an increased risk of air and water pollution. Due to open-space waste disposal practices, animals and scavengers might get infected, leading to the scattering of waste and the spreading of infections. In countering such activities, four major principle functions of BMW management are applicable: the placement of bins at the source of generation of BMW, segregation of BMW, removal or mutilation of the recyclable waste, and disinfection of the waste [ 10 ]. BMW management methods aim predominantly to avoid the generation of waste and, if generated, then recover as much as possible [ 11 ].

BMW management rules in India

On March 28, 2016, under the Environment (Protection) Act, 1986, the MoEF notified the new BMW Rules, 2016 and replaced the earlier Rules (1988). BMW produced goes through a new protocol or approach which helps in the appropriate management of waste, i.e., its characterization, quantification, segregation, storage, transport, and treatment, all of which aim to decrease environmental pollution [ 12 ]. Problems with the improper management of BMW also shed light on the scavengers who, for recycling, segregate the potentially hazardous BMW without using gloves or masks. Strict rules have been implemented to ensure that there is no stealing of recyclable materials or spillage by some humans or animals and that it is transported to the common BMW treatment facility [ 10 ]. The first solution to stop the spread of hazardous and toxic waste was incineration. Incineration is required in all hospitals and healthcare facilities that produce BMW. However, due to the absence of services that provide certified incinerators in a few countries, BMW has to be sent to landfills, which leads to land contamination and harms the environment [ 13 ]. Incinerators used for disposal might also lead to environmental pollution. Numerous toxins are formed during incineration, which are the products of incomplete combustion. Thus, some new standards have been issued to resolve this problem and safeguard the environment and public health [ 14 ].

Steps in the management of BMW

BMW management needs to be organized, as even a single mistake can cause harm to the people in charge. There are six steps in the management of BMW [ 15 ]: surveying the waste produced; segregating, collecting, and categorizing the waste; storing, transporting, and treating the waste. Segregation is the separation of different types of waste generated, which helps reduce the risks resulting from the improper management of BMW. When the waste is simply disposed of, there is an increased risk of the mixture of waste such as sharps with general waste. These sharps can be infectious to the handler of the waste. Further, if not segregated properly, there is a huge chance of syringes and needles disposed of in the hospitals being reused. Segregation prevents this and helps in achieving the goal of recycling the plastic and metal waste generated [ 16 ]. According to Schedule 2, waste must be segregated into containers at the source of its generation, and according to Schedule 3, the container used must be labeled. The schedules of BMW (Management and Handling) Rules, 1998, which were initially ten in number, have now been reduced to four [ 17 ]. The collection of BMW involves the use of different colors of bins for waste disposal. The color is an important indicator for the segregation and identification of different categories of waste into suitable-colored containers. They must be labeled properly based on the place they have been generated, such as hospital wards, rooms, and operation theatres. It is also very important to remember that the waste must be stored for less than 8-10 hours in hospitals with around 250 beds and 24 hours in nursing homes. The storage bag or area must be marked with a sign [ 16 ]. 

Figure ​ Figure1 1 shows the biohazard signs that symbolize the nature of waste to the general public.

Biohazards are substances that threaten all living things on earth. The biohazard symbol presented in Figure ​ Figure1 1 was remarked as an important public sign, signaling the harms and hazards of entering the specified zone or room [ 18 ]. Along with the biohazard sign, the room door must have a label saying “AUTHORISED PERSONNEL ONLY.” The temporary storage room must always be locked and away from the general public's reach. The waste is then collected by the vehicles daily. A ramp must be present for easy transportation. The waste collected is then taken for treatment. The loading of wastes should not be done manually. It is very vital to properly close or tie the bag or the container to avoid any spillage and harm to the handlers, the public, and the environment. The transport vehicle or trolley must be properly covered, and the route used must be the one with less traffic flow [ 19 ].

BMW handling staff should be provided with personal protective equipment (PPE), gloves, masks, and boots. BMW retrievers must be provided with rubber gloves that should be bright yellow. After usage, the importance of disinfecting or washing the gloves twice should be highlighted. The staff working in or near the incinerator chamber must be provided with a non-inflammable kit. This kit consists of a gas mask that should cover the nose and mouth of the staff member. The boots should cover the leg up to the ankle to protect from splashes and must be anti-skid [ 16 ]. According to the revised BMW management rules, 2016, it is mandatory to provide proper training to healthcare facility staff members on handling BMW. The training should be mandatorily conducted annually. Along with the management step of the color coding for segregation, it is also important for the staff to be trained in record keeping. This practice of record-keeping helps track the total amount of waste generated and the problems that occurred during the management process, thus helping improve segregation, treatment, and disposal [ 20 ].

Color coding for segregation of BMW

Color coding is the first step of BMW management. Different wastes are classified into different types, and therefore, they must be handled and disposed of according to their classification. The bins used for waste disposal in all healthcare facilities worldwide are always color-coded. Based on the rule of universality, bins are assigned a specific color, according to which the waste is segregated. This step helps avoid the chaos that occurs when all types of waste are jumbled, which can lead to improper handling and disposal and further result in the contraction of several diseases [ 21 ]. The different kinds of categories of waste include sharp waste such as scalpels, blades, needles, and objects that can cause a puncture wound, anatomical waste, recyclable contaminated waste, chemicals, laboratory waste such as specimens, blood bags, vaccines, and medicines that are discarded. All the above-mentioned wastes are segregated in different colored bins and sent for treatment [ 22 ]. Yellow bins collect anatomical waste, infectious waste, chemical waste, laboratory waste, and pharmaceutical waste, covering almost all types of BMW. Different bins and various types of sterilization methods are used depending on how hazardous the waste is. The best tools for sterilization are autoclaves. Red bins collect recyclable contaminated wastes, and non-chlorinated plastic bags are used for BMW collection. Blue containers collect hospital glassware waste such as vials and ampoules. White bins are translucent where discarded and contaminated sharps are disposed of. Sharp wastes must always be disposed of in puncture-proof containers to avoid accidents leading to handlers contracting diseases [ 23 , 24 ]. 

Figure ​ Figure3 3 illustrates the different colored bins used for the segregation of BMW.

BMW management refers to completely removing all the hazardous and infectious waste generated from hospital settings. The importance of waste treatment is to remove all the pathogenic organisms by decontaminating the waste generated. This helps in the prevention of many severe health-related issues that can be caused because of the infective waste. It is a method used to prevent all environmental hazards [ 25 ].

Methods for the treatment of BMW

There are many methods that are used for the treatment of BMW. One of the most economical ways of waste treatment is incineration, which is just not some simple “burning” but the burning of waste at very high temperatures ranging from 1800℉ to 2000℉ to decrease the total mass of decontaminated waste by converting it into ash and gases, which is then further disposed of in landfills [ 25 , 26 ]. Important instructions associated with the use of incinerators are as follows: chlorinated plastic bags must not be put inside the incinerators as they can produce dioxin [ 26 ]. Metals should not be destroyed in an incinerator. The metals present in BMW are made of polyvinyl chloride. When these metals are burned, they produce a huge amount of dioxin. Dioxins are very toxic chlorinated chemical compounds, as dioxins, when released into the environment, can lead to environmental pollution and a higher incidence of cancer and respiratory manifestations [ 14 ].

Autoclaving is an alternate method of incineration. The mechanism of this process involved sterilization using steam and moisture. Operating temperatures and time of autoclaving is 121℃ for 20-30 minutes. The steam destroys pathogenic agents present in the waste and also sterilizes the equipment used in the healthcare facility [ 25 ]. Autoclaving has no health impacts and is very cost-friendly. It is recommended for the treatment of disposables and sharps, but the anatomical, radioactive, and chemical wastes must not be treated in an autoclave [ 27 ]. Chemical methods are the commonest methods that include chemicals such as chlorine, hydrogen peroxide, and Fenton’s reagent. They are used to kill the microorganisms present in the waste and are mainly used for liquid waste, such as blood, urine, and stool. They can also be used to treat solid waste and disinfect the equipment used in hospital settings and surfaces such as floors and walls [ 28 ]. Thermal inactivation is a method that uses high temperatures to kill the microorganisms present in the waste and reduce the waste generated in larger volumes. The temperature differs according to the type of pathogen present in the waste. After the treatment is done, the contents are then discarded into sewers [ 29 ].

Very serious environmental and health hazards can be triggered if hospital waste is mixed with normal garbage, which can lead to poor health and incurable diseases such as AIDS [ 30 ]. The needle sticks can be highly infectious if discarded inappropriately. Injury by these contaminated needles can lead to a high risk of active infection of HBV or HIV [ 31 ]. The groups at increased risk of getting infected accidentally are the medical waste handlers and scavengers. Sharps must properly be disposed of in a translucent thin-walled white bin. If sharps are discarded in a thin plastic bag, there is a high chance that the sharps might puncture the bag and injure the waste handler [ 32 ]. It can also be the main cause of severe air, water, and land pollution. Air pollutants in BMW can remain in the air as spores. These are known as biological air pollutants. Chemical air pollutants are released because of incinerators and open burning. Another type of threat is water pollutants. BMW containing heavy metals when disposed of in water bodies results in severe water contamination. The landfills where the disposal takes place must be constructed properly, or the waste inside might contaminate the nearby water bodies, thus contaminating the drinking water. Land pollution is caused due to open dumping [ 33 ]. BMW must also be kept away from the reach of rodents such as black rats and house mice, which can spread the pathogens to the people living nearby [ 34 ].

Many promising steps were taken to minimize the volume of waste discarded from the source, its treatment, and disposal. The 3R system encourages the waste generators to reuse, reduce, and recycle. Everyone must be aware of the 3Rs because this approach can help achieve a better and cleaner environment [ 35 ]. Unfortunately, most economically developing countries cannot correctly manage BMW. Very few staff members of healthcare facilities are educated about proper waste management. The waste handlers are also poorly educated about the hazards of waste [ 36 ]. Every member helping in the waste management process must be made aware of the dangers of BMW to avoid accidents that harm the environment and living beings [ 37 ].

Conclusions

BMW is generated by healthcare facilities and can be hazardous and infectious. Improper handling can lead to health hazards. Collection, segregation, transportation, treatment, and disposal of BMW are important steps in its management. The color coding of bins, the use of technologies such as incineration and autoclaving, and attention to environmental impacts are also highly crucial. BMW management aims to reduce waste volume and ensure proper disposal. All those involved should strive to make the environment safer.

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The authors have declared that no competing interests exist.