research paper about proper waste disposal

• Research article
• Open access
• Published: 05 January 2022

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  

BMC Public Health volume  22 , Article number:  1 ( 2022 ) Cite this article

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

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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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Assessment of demographics and motivations of post-consumer textile waste management using a bibliometric approach

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• Published: 04 June 2024

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• Amal Ben Abdallah 1 ,
• Sagar Ray 1 ,
• Sharmin Jahan Mim 1 ,
• Tanvir Shahrier Mahmud 1 ,
• Amy Richter 1 &
• Kelvin Tsun Wai Ng   ORCID: orcid.org/0000-0002-2045-9367 1  

Proper management of post-consumer textile waste (PCTW) is vital to the sustainable development of circular economy. This study systematically analyze PCTW studies from 1995 to 2021 focusing on demographics, motivations, and reasons of PCTW management. A PRISMA approach is adopted for the bibliometric analysis. It is found that very few PCTW studies focused on the behavioral, physiologic, and cultural aspects. Recently, there is an increasing trend in PCTW publications, with a 73% increase in research output over the 15 years. USA stands out as the most productive country. Demographics such as income, age, and gender appeared to be the most significant role in shaping consumer behaviors, contributing to around 50% of the studies. There is a lack of studies involving participants below the age of 18, omitting one of the key stakeholders of PCTW management. We found gender bias in research participants, and many published PCTW studies focused exclusively on female consumers. Convenience and the condition of clothing items are important factors influencing consumer-disposal decisions, while environmental concerns are pivotal motivations driving recycling behaviors. More studies on gender stereotyping and cultural appropriation are recommended to better understand PCTW generation, recycling, and disposal behaviors.

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Acknowledgements

The research reported in this paper was supported by a grant from the Natural Sciences and Engineering Research Council of Canada (DH-2023-00488) to the corresponding author. The lead author (Amal Ben Abdallah) was also supported by a Mitacs Globalink research award. The authors are grateful for their support. The views expressed herein are those of the writers and not necessarily those of our research and funding partners.

Natural Sciences and Engineering Research Council of Canada, DH-2023-00488, Kelvin Tsun Wai Ng

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Amal Ben Abdallah: writing — original draft. Sagar Ray: writing — original draft, validation, methodology. Sharmin Jahan Mim: writing — original draft, validation, methodology. Tanvir Shahrier Mahmud: writing — original draft, validation, methodology. Amy Richter: writing — review and editing, formal analysis. Kelvin Tsun Wai Ng: writing — review and editing, conceptualization, supervision.

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Abdallah, A.B., Ray, S., Mim, S.J. et al. Assessment of demographics and motivations of post-consumer textile waste management using a bibliometric approach. J Mater Cycles Waste Manag (2024). https://doi.org/10.1007/s10163-024-01994-8

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Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries

Rajanbir kaur.

1 Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab 143005, India

Kanwaljit Kaur

2 Govt. Polytechnic College for Girls, Amritsar, India

Rajinder Kaur

Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.

1. Introduction

According to World Health Organization, a person aged 10–19 years is considered as an adolescent [ 1 ]. The transition period between the childhood and adulthood is called adolescence which is marked with the growth and development of the child. During this period, physical, psychological, and biological development of the child occurs [ 2 ]. It is recognized as a special period in a girl's life cycle which requires special attention. Menarche is an important biological milestone in a woman's life as it marks the onset of the reproductive phase of her life. The average age at menarche is mostly consistent across the populations, that is, between 12 and 13 years of age [ 3 , 4 ]. Unfortunately, due to lack of knowledge on menstruation preparedness and management or due to shyness and embarrassment the situation becomes worse for girls [ 5 ]. Menstruation is a natural process but it is still a taboo in Indian society as it is considered unclean and dirty [ 6 ].

Menstruation wastes are the wastes that are generated by a female in her reproductive years. These wastes are produced during menstruation commonly known as menses, periods, or monthly bleeding cycle [ 7 ]. The menstrual cycle has three phases, that is, follicular phase (proliferative), ovulation phase, and luteal phase (secretory). Menstruation is regulated by hormones; in this process, endometrium, lining of uterus, gradually thickens and sheds off and causes bleeding that normally last for 3–5 days and occasionally up to 7 days. Menstruation sheds two-thirds of the endometrial lining. In addition to blood, menstrual fluid contains mucus and vaginal secretions [ 8 ]. The menstrual flow varies from female to female and may be more or less at the beginning of menses or may change throughout the cycle. The color of the menstrual fluid varies between red, bright red, and dark brown to black. Menstrual fluid may or may not have unpleasant odour especially when it comes in contact with air. Menstrual flow or duration also changes before menopause or during gynaecological cancers. Under conditions of hormonal imbalance, fibroids, polyps, and endometriosis menstrual flow increase and excessive loss of blood through menstruation can lead to anaemia.

Women have developed their own personal strategies to handle this period of time. Globally, these strategies vary greatly due to the personal preferences, availability of resources, economic status, cultural traditions and beliefs, education status, and knowledge about menstruation. Practices related to menstruation hygiene are of major concern as it has a health impact; if neglected, it leads to toxic shock syndrome, reproductive tract infections (RTI), and other vaginal diseases [ 9 – 11 ]. Poor genital hygiene negatively affects adolescents' health. Most girls are unaware and unprepared for menarche as they are not informed or ill-informed about menstruation [ 12 ]. The main objective of this review was to summarize the concern and possible methods of menstrual waste management in low-income countries. The review article was aimed at understanding the menstrual practices, product design, demands, and disposal strategies. It includes both a summary of the existing menstrual hygiene needs and management and also an analysis of the current knowledge in the fields of public health, water and sanitation, and solid waste management.

2. Cultural Beliefs and Restrictions during Menstruation

Menstrual hygiene practices were affected by cultural norms, parental influence, personal preferences, economic status, and socioeconomic pressures. Menstrual beliefs refer to misconceptions and attitudes towards menstruation within a given culture or religion. Menstrual beliefs, knowledge, and practices were all interrelated to the menstrual hygiene management [ 13 , 14 ]. By reviewing literature and articles published in journals and reports available on the Internet we found many cultural and religious beliefs followed by people regarding menstruation. These norms were the barriers in the path of good menstrual hygiene practices. Many women experiencing restrictions on cooking, work activities, sexual intercourse, bathing, worshipping, and eating certain foods [ 15 ]. These restrictions were due to the overall perception of the people regarding menstruation as they consider it dirty and polluting [ 16 ].

In some parts of the country there were restrictions on bathing and a taboo against burial of bloodied menstrual cloth. Cloths should first be washed and then buried or reused. Washing and drying thought to be done secretly or in a hidden corner so that it cannot be seen by others [ 17 ]. It was also believed that menstrual fluids may be misused for black magic, so women should wash the wrapper/cloth wore during menses only at night when others were asleep [ 18 ]. Menstrual flow was seen as dirty, polluting, and shameful, so women hide menstrual cloths for fear of being cursed. In similar findings, it was believed that menstrual waste was linked to witchcraft and danger, so it must be buried unless witches go after human blood and find the menstrual wrapper/cloth and destroy the women by causing infertility [ 13 ]. From all these beliefs, it was clear that education plays a key role in menstruation hygiene management. By educating both men and women regarding menstruation, we can overcome these false beliefs and taboos. Due to cultural expectations and restrictions many girls were not adequately informed about the realities of menstruation. As a result, they feel subnormal, diseased, or traumatized [ 19 ]. Unprepared girls were frightened, confused, and feel embarrassed by menarche likely to develop negative attitudes towards menstruation [ 20 ]. Even touching of menstruating women was considered toxic, they were prohibited from cooking and from taking certain foods like pickle. These prohibitions are more in the rural areas than in the urban areas. They were also not allowed to participate in religious activities or to contact religious articles [ 21 ]. Menstruating girls are also not allowed to bath and wash hair, as it is believed to impede blood flow.

3. Types of Absorbents Used during Menstruation

The preference of sanitary protection material is based on personal choice, cultural acceptability, economic status, and availability in local market. Along with basic sanitation facilities, one should be also provided with soap and menstrual absorbents to manage menstruation hygiene. The choice of absorbents varies among rural and urban women and girls. In rural areas, the most preferred absorbents are reusable cloth pads and in urban areas women prefer to use commercial sanitary pads. Chlorine-bleached Kraft or sulphate pulp is used by manufacturers to produce fluff pulp as absorbent used to make disposable sanitary products. Nowadays, many deodorised and non-deodorised sanitary products are available in the market made of synthetic fibre rayon. These deodorised products contain chemicals like organochlorines which have antibacterial activity. Due to their chemical composition, these products when buried in the soil they kill the soils microflora and delay the process of decomposition [ 22 ]. Different menstrual products used by women/girls are discussed below ( Figure 1 ).

Types of sanitary products used by women during menstruation are (a) reusable cloth pads ( https://www.etsy.com/market/cloth_menstrual_pads ); (b) commercial sanitary pads ( http://topyaps.com/things-girl-must-know-about-sanitary-pads ); (c) tampons ( http://www.womensvoices.org/tag/tampons/ ); (d) pads made from banana fibre ( https://saathipads.com/ ); (e) sea sponges used as sanitary material ( https://www.pinterest.com/pin/194640015120225878/ ); (f) pads made up of water hyacinth ( https://www.ecouterre.com/jani-a-biodegradable-sanitary-napkin-made-from-water-hyacinth/ ); (g) menstrual cup ( http://rubycup.com/blog/how-to-clean-the-suction-holes-of-your-menstrual-cup/ ); (h) pads made from wool ( https://www.pinterest.com/pin/198088083583361670/ ); (i) reusable tampons ( http://naturalparentsnetwork.com/reusable-menstrual-products/ ).

3.1. Reusable and Washable Cloth Pads

They may be sustainable sanitary option but must be hygienically washed and dried in the sunlight. The sun's heat is a natural sterilizer and drying the cloths/cloth pads under it sterilizes them for future use. These cloth pads are reusable so they are cost-effective, easily available, and ecofriendly. They also need to be stored in a clean dry place for reuse to avoid contamination.

3.2. Commercial Sanitary Pads

They are easily available at many stores, chemist shops, or online. They are expensive, compared to cloth pads, nonreusable, and not very environment-friendly. The cotton used in their making is not 100% natural and may contain pesticides.

3.3. Tampons

They are the type of absorbent that provides internal protection. They are kind of plug of soft material (cotton) which is inserted into the vagina to absorb the menstrual flow before it leaves the body. They are expensive, not easily degradable in nature and, hence, not very environmental friendly. Nowadays, sea sponge tampons are available in the market which are a natural alternative to synthetic tampons.

3.4. Reusable Tampons

These are washable tampons made up of natural materials like bamboo, wool, cotton, or hemp. They are also knitted or crocheted using the natural absorbent material like cotton or wool. They are inserted into the vagina to absorb menstrual flow same as the disposable tampons.

3.5. Menstrual Cups

They may be a new technology for poor women and girls and an alternative to sanitary pads and tampons. They are like cups made of medical grade silicone rubber which makes the cup easy to fold and get inserted into the vagina to collect menstrual blood. They can be worn up to 6–12 hours depending upon the amount of menstrual flow, so it needs to be removed and emptied less frequently. They are reusable and environment-friendly. It offers sustainable, practical, and cost-effective alternative where sanitation conditions are not good.

3.6. Bamboo Fibre Pads

Instead of wood pulp, bamboo pulp is used as an absorbing material in these sanitary pads. It has more absorbing capacity and is safer to use. They are affordable, easily decomposed, and environment-friendly pads which also possess antibacterial properties. This provides infection and irritation-free menstruation. Also, bamboo charcoal pads are available in the market with advantage that blood stains are not clearly visible and are also reusable in nature.

3.7. Banana Fibre Pads

Nowadays, low-cost sanitary pads for rural women made from waste banana tree fibre were sold under trade name “Saathi” in India. They are environment-friendly and decompose within six months after use. Besides these products, women in the remote rural areas also use natural materials like cow dung, leaves, and mud ( https://sswm.info/category/background/background/background/health-and-hygiene-issues/menstrual-hygiene-management ).

3.8. Water Hyacinth Pads

Menstrual pads manufactured using water hyacinth is sold under trade name “Jani.” They are cost-effective, easily biodegradable, and ecofriendly in nature.

4. Menstrual Waste Disposal Techniques Used by Women

Appropriate disposal of used menstrual material is still lacking in many countries of the world. Most of the countries have developed techniques to manage their fecal and urinary wastes but, because of lack of menstrual management practices in the world, most of the women dispose of their sanitary pads or other menstrual articles into domestic solid wastes or garbage bins that ultimately become a part of solid wastes. Toilet facilities in India lack bins for the disposal of sanitary pads and hand washing facilities for menstruating women to handle menstrual hygiene. In urban areas, where modern disposable menstrual products are used they dispose of them by flushing in toilets and throwing in dustbins or through solid waste management [ 23 ], but, in rural areas, there are many options for disposing menstrual waste such as by burying, burning, and throwing in garbage or in pit latrines. In rural areas, mostly women use reusable and non-commercial sanitary materials like reusable pads or cloths. Thus, they generate lesser amount of menstrual waste as compared to women in urban areas who rely on commercial disposable pads. The menstrual material was disposed of according to the type of product used, cultural beliefs, and location of disposal. In slum areas, women dispose their menstrual waste into pit latrines as burning and burial were difficult due to limited privacy space [ 24 ]. The reason behind that is it was seen by men or used in witchcraft.

In schools, due to lack of sanitary facilities, girls throw their pads in toilets. In some cases, girls threw away their used menstrual clothes without washing them. Also many were reported being absent from school due to lack of disposal system, broken lock/doors of toilets, lack of water tap, bucket, and poor water supply [ 25 , 26 ]. In some schools, incinerators or “feminine hygiene bins” are used for disposing menstrual waste material but due to shyness or fear of being seen by others they refrained from using it [ 27 ]. The behavior of women regarding disposal is different when being at home and away from home. At home, they dispose the waste by wrapping and throwing in the dustbin along with other domestic waste. As mentioned above, the disposing habits change according to the place. In public places, prior to having knowledge about the consequences of flushing the pads, they flush them in the toilets or wrap and throw them in the dustbins. Where dustbins are not placed they leave the soiled pads wrapped or unwrapped in the toilet corners. This makes the toilets dirty, breeding place for flies and mosquitoes, and also unhygienic for other toilet users and cleaners. In many cities, the persons who manage the public toilets always complain of blockage of sewage system because of flushing of sanitary pads or rags in the toilet.

5. Consequences of Menstrual Waste Disposal

As sanitation systems were designed with urine and feces in mind, they are unable to cope with the menstrual absorption materials. These absorption materials clog the sewer pipelines as they are unable to pass through and cause the system backflow [ 28 ]. Materials like tampons, cotton wool, toilet paper, and other organic materials used for menstrual management might be decomposed in pit latrines/landfills except the plastic inlay of the commercial sanitary pads. Sanitary napkins might decompose over a period of about one year except its plastic lining in on-site sanitation [ 29 ].

In rural areas, pit latrines once full they were covered with soil and new pit was dug but due to space limitations this was not practiced in urban areas [ 30 ]. It was reported that some women and girls wrap their used menstrual cloths and packs in polythene bags before disposing in pit latrines which prevents them from decomposition. Nowadays, mostly women/girls prefer commercial sanitary pads and tampons which are made up of superabsorptive materials like polyacrylate. These pads and tampons when flushed in the toilets they get saturated with liquid and swell up, thus resulting in sewage backflow, a serious health hazard. The adhesive wings and the perforated plastic layers in the commercial sanitary napkins are not easily biodegradable. The sewage blockages were mostly due to accumulation of excessive quantity of solid waste or sand which results in hardening of the sludge in the pits. Blockage of sewage system is a global problem and major contributing factor is flushing of menstrual products in toilets. Deodorised sanitary products used by women/girls contain chemicals used in bleaching such as organochlorines which when buried in the soil disturb the soil microflora and decomposition takes time [ 22 ].

People living alongside river banks throw menstrual waste into water bodies which contaminate them. These materials soaked with blood were breeding places for germs and pathogenic microbes [ 31 ]. Sanitary products soaked with blood of an infected women/girl may contain hepatitis and HIV viruses which retain their infectivity in soil and live up to six months in soil. The clogged drainage with napkins has to be unblocked and cleaned manually by conservancy workers with their bare hands without proper protection and tools. This exposes the workers to harmful chemicals and pathogens. Incineration is a better technique to dispose of menstrual waste but burning of pads releases harmful gasses that effects health and environment. Burning of inorganic material at low temperature releases dioxins which are toxic and carcinogenic in nature.

6. Role of Men/Boys towards Menstrual Hygiene Management

One of the main reasons why menstruation is a taboo and menstruation hygiene is neglected is gender inequality. Unequal rights given to men and women result in women's voices being ignored within households and communities and in development programmes. Due to cultural norms and stigmas, menstruating women are not allowed to use water and sanitation facilities and in some cases even excluded from home as menstruation is considered impure [ 32 , 33 ]. Therefore, comprehensive programmes that engage both men and women should be organized related to menstrual hygiene.

Men can support and influence women and girls in managing menstruation in households, schools, work, and community through many roles as husbands, fathers, brothers, students, teachers, colleagues, leaders, and policymakers. By reviewing literature, it was found that at household level men do not support women regarding menstruation hygiene and never have they discussed menstrual issues with their wives and daughters. As they are decision-makers at household level, in many cases they do not give money to buy menstrual products such as commercial sanitary pads, tampons, and menstrual cups as they consider it money wastage. So women have to rely on cheap reusable cloth pads which they have to wash, dry, and use again. In other cases, due to low family income, men hesitate to give money for such costly products. So, in both cases, women have to compromise with their menstrual needs and personal hygiene [ 34 ].

Decisions related to constructing toilets in houses are also taken by male members. So it is a big barrier in menstrual hygiene as women find it difficult in cleaning and changing menstrual materials in privacy [ 35 ]. Women and girls who have toilets at home feel shy and embarrassed as the drain that leads out is not covered and there is a chance of seeing blood flowing in drain by others [ 36 , 37 ]. In some reports, it was found that parents did not allow boys to discuss such topic as they were not important for their future, so the boys received information about menstruation from friends and Internet which is inaccurate and incomplete. In some places, like in Nepal, menstruating women have to live separately in a “chhaupadi” during menstruation outside the house. This cultural norm is supported by both men and women making it difficult to survive for a menstruating women/girl during winters [ 38 ]. They also have to face many challenges living in chhaupadi's such as getting bitten by snakes, fires, and rapes.

Most men do not know about the menstruation and physiological changes in women during menstruation and menstrual cycle, so it is difficult to change their perception regarding menstruation and menstrual hygiene. Due to unwillingness, myths, prejudices, and misconceptions, it is difficult to talk about menstruation with men and boys. But by engaging them into group discussions and regular community meetings, we can change their perception and make them aware about their role regarding menstrual hygiene management. In India, a man named “Arunachalam Muruganantham” known as “India's Menstrual Man” develops an inexpensive and environment-friendly machine which produces semibiodegradable sanitary pads. Men can help women and girls by constructing toilets, incinerators, and latrines with chutes at homes and schools and at community level. At household level, they help by providing toilet facilities with privacy, water, and soap and by giving them money for menstrual products. As the decision-making power is in men's hand, making household budgeting for sanitary materials supports and empowers women by allowing them to move freely with lower risk of stains. Men who are in politics support menstrual hygiene management by making girls/women friendly policies, by providing sanitary materials free of cost or at affordable prices, by providing water and sanitation in their areas, and by conducting seminars and workshops in rural areas.

7. Role of Teachers in Creating Awareness regarding Menstruation and Menstrual Waste Management

In schools, teachers can make the school environment girl/women friendly to manage menstruation with dignity. Sex education in schools helps adolescents to discover their sexual identity, to protect themselves from sexual abuse, unwanted pregnancies, and sexually transmitted diseases, and to know physiological changes occurring in the body and how to take care of personal hygiene [ 39 ]. In most of the cases, teacher's attitude is not good and supportive towards menstruating girls in schools. Different views of parents, teachers, and society affect sex education being taught in schools and colleges. Cultural, religious, and social barriers also create hindrance in the path of sex education [ 40 ].

Our education sector plays an important role in child's growth and development by allowing them to respond to changes and challenges they are facing in day-to-day life [ 41 ]. But many times it avoids issues related to the menstruation and menstrual hygiene management by considering it one's personal matter and should be discussed within the house. Menstruation is a silent issue in girl's life which is further affected by teacher's attitude, school environment, and infrastructure. Because of this. many girls remain absent from schools during this time. Sex education is often neglected from the school curriculum which negatively impacts the student's life. They get information about puberty, sexual intercourse, menstruation, and other physiological changes in one's body from books, friends, and Internet which may be incomplete or inaccurate. Due to lack of knowledge and social interaction, teasing and taunting with hurtful nicknames are common in schools. This makes it difficult for a girl student to survive in this environment, so they remain absent from school.

In many schools, both male and female teachers are not ready to discuss menstruation and menstrual hygiene management with students. The female teachers are also not available in many schools. Teachers often skip such topics in books as they do not want any open discussion in the class or to escape from the questions asked by students. Teachers also feel shy and embarrassed to discuss such topics in class due to language barrier [ 42 ]. In most schools, English is not a compulsory subject so teachers have to discuss them in local language and using vernacular words in front of students is an embarrassing thing. Due to unsupportive environment in the schools, it was also found that some girls hesitate to stand to answer teacher's questions in fear of leakage or smell and also hesitate to write on blackboard in fear of any menstrual accident and blood stains on clothes seeing by others. In some reported cases, parents do not allow girls to go to schools upon reaching puberty in fear of sexual harassment by boys and male teachers in schools [ 43 ].

To overcome these issues, male teachers and employees in the schools and institutes should be well educated and confident regarding menstruation and menstrual hygiene management so that they support girls/women by providing safe environment and privacy. A committee of teachers including both male and females should be made in the schools to collect funds for providing sanitary napkins, soaps, water, and toilet facilities in schools so that girls manage their menstruation with ease and safety. Committee should also provide dustbins for menstrual waste disposal. Separate toilets for girls and boys with proper doors and locks should be built in the schools. Teachers should educate girls about menstrual health management and its link to their health. They should also make girl students aware of how to dispose of used menstrual products at home and in schools and about the consequences of throwing them in open or flushing them in toilets. Open discussions on puberty, sex education, menstruation, and so forth should be organized by schools in every class to make students aware. This will solve their unsolved queries by providing them correct knowledge, promote social interaction, and also develop a trust relationship with fellow friends and teachers. School-level health policies should be made by school management committee to promote and educate students regarding health and safety, to ensure adequate water and sanitation facilities, and to protect girl students and staff from bullying and sexual harassment.

Some Case Studies

Recently in a school in Tamil Nadu, a 12-year-old school girl of 7th class committed suicide after menstrual shaming. According to her mother, her periods started during a class where she was given a duster cloth to be used as a pad. Then reportedly, she was forced to leave the classroom when her clothes got stained by blood. The next day she did not bear the humiliation and committed suicide due to harassing and torturing by the teacher in the class as written in the suicide note (source: http://www.bbc.com/news/world-asia-india-41107982 ).

Around 70 girls of the Kasturba School hostel were ordered to remove their clothes by the hostel warden to check for menstrual blood after she found blood stains in the washroom. This shameful act happened in Muzaffarnagar (UP) in March 2017 (source: https://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cms ).

8. Strategies for the Management of Menstrual Waste

• Disposal of menstrual waste is of major concern as it affects health and environment. There is a need for effective menstrual materials which needs less and cost-effective management.
• Companies dealing with manufacturing of sanitary pads or other articles should disclose the information on the pads regarding the chemical composition of the pads so that appropriate technologies could be used for their disposal and treatment.
• Environment-friendly chemicals should be used by manufacturers of sanitary products to stop soil and water pollution and to fasten the decomposition process.
• Guidance regarding menstrual management to adolescent girls and women is a much needed step. Menstrual hygiene management should be an integral part of education curriculum.
• Distribution of menstrual products should be free of cost in schools and educational institutes [ 44 ]. Recently, instead of subsidizing the menstrual pads, Indian government has imposed 12% GST on them which is not very women friendly (source: http://www.livemint.com/Industry/2Y4RRe0XaJmVduujmsDdXL/GST-rate-on-sanitary-napkins-fixed-at-12.html ).

Sanitary napkin vending machine. Source: https://timesofindia.indiatimes.com/city/pune/sanitary-napkin-vending-machines/articleshow/57824878.cms .

• There should be a separate collection system for the menstrual wastes without affecting the privacy and dignity of women. Specific sanitary dispensers to collect menstrual waste should be installed.
• There should be sufficient space for washing, cleaning private parts and hands and for changing or dealing with stained clothes. To fulfil these requirements, there must be water availability, toilet paper, dustbin, and a sink to wash menstrual products.
• Dustbins should be covered by lid and emptied from time to time to keep the toilets clean from flies, mosquitoes, and bad odour.
• Covered containers and dustbins have advantage of hiding the waste being seen by others. They are installed in a place that offers privacy [ 21 ].
• Gloves and proper safety tools should be provided to the cleaners so that they are not exposed to pathogenic organisms and harmful gasses.
• Government should introduce new rules for the safe disposal and treatment of menstrual wastes as they have made for solid or biomedical wastes. Appropriate policy and legal framework is necessary for the management of menstrual wastes.
• Government and non-government organizations should come forward for making the people aware of management of menstrual wastes. Government should give the funds to the Municipal Corporation or NGOs for the construction of women friendly toilets.
• Health implications of menstrual wastes should be properly investigated. Financial support should be given to the institutions to carry out the research in the management of menstrual wastes.
• Scientific research should be encouraged for the most suitable techniques of disposal of sanitary pads or other menstrual products.
• Allocation of budget in schools to support menstrual hygiene management studies should be conducted.
• Collaborative efforts (trash bins) should be made.
• Incinerators are a better option for disposal but should be operated in a controlled environment so that harmful gasses emitted will not harm larger area.

9. Better Ways/Ideas of Disposing Menstrual Wastes

9.1. incinerators.

If incinerators are used according to ecofriendly guidelines they create less pollution. They should be operated at certain specific temperature around 800°C so that they emit less harmful gasses. They should be installed in schools, institutions, and slum areas and at community level ( Figure 3 ).

Incinerator installed in the toilet for easy sanitary products disposal. Source: http://www.vendingbiz.in/sanitary-napkin-incinerators-napkinci-maxi-1902444.html .

9.2. Latrines with Chutes

These are special kind of toilets in which a shoulder level Chute was made in the usual deep pit. A chemical agent was added to the pit five times in a month to enhance the decomposition process of used napkins.

9.3. Reusable Cloth Pads

Using these reusable cloth pads is a better option as they have less chemical and plastic content. So they are easily decomposable as compared to other commercial products.

9.4. Biodegradable Products

Commercial sanitary product manufacturing companies must manufacture products having lesser chemical and plastic content. Pads made from bamboo fibre, banana fibre, water hyacinth, and sea sponges should be encouraged.

9.5. Clay or Cemented Incinerators

Clay and cement incinerators used in Gujrat villages by “Vatsalya Foundation” are a welcomed step in menstrual hygiene management. A lady named “Swati” designed this incinerator and named it “Ashudhinashak” which burns many sanitary napkins at a time without creating any smoke. This ecofriendly and cheap innovation is appreciated by rural women who found difficulty in disposing them ( Figure 4 ).

Incinerators used to dispose of menstrual waste in rural areas of India: (a) clay incinerator ( http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkins ); (b) mud incinerator ( https://www.thebetterindia.com/87876/master-art-deal-with-menstrual-waste/ ); (c) cement incinerator ( http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkins ).

9.6. Better Disposal Techniques

Special covered bins should be installed to handle menstrual waste. Disposal bags should be provided by manufacturing companies with color indication for disposing these products. These bags should be freely distributed among schools and institutions. Menstrual waste should not be disposed of along with domestic waste. Pads should be properly wrapped in newspaper and then thrown in the dustbins. By this it should also be safe for rag pickers as it does not expose them to any disease-causing pathogens.

10. Conclusions

Menstrual hygiene should be promoted by implementing a course on menstruation and menstrual hygiene management. Teachers should be educated and trained to impart knowledge about menstruation and menstrual hygiene management among students. Social and electronic media also play an important role to make the girls and women aware about the latest menstrual products, different manufacturers, government policies, and so forth. Subsidies should be given on menstrual products so that every girl/women can afford them easily. Non-government organizations should come forward to educate rural people about menstruation, menstrual hygiene management, importance of toilets at homes, hand washing, diseases related to reproductive tract due to poor hygiene, and so forth. Emphases should be given on the use of reusable sanitary or cloth pads to overcome the problem of disposal. Girls and women should be aware of the consequences of disposing used menstrual products in open or flushing them in toilets. Dustbins with proper lids should be placed in the toilets. If possible, incinerators should be installed at homes, schools, and community levels. This study reveals that lack of privacy is a major concern both in household and in schools. Also, ignorance, misconceptions, unsafe practices, and illiteracy of the mother and child regarding menstruation are the root causes of many problems. So, there is a big need to encourage adolescents at school levels to practice safe and hygienic behaviors.

Acknowledgments

The authors are highly thankful to University Grants Commission for providing financial assistance under UPE (University with Potential for Excellence) scheme and Guru Nanak Dev University, Amritsar, for providing necessary infrastructure to carry out the research work.

Conflicts of Interest

The authors of this paper have no conflicts of interest.