The design was cross-sectional study. The study was conducted at Kabgayi District Hospital located in Southern Province of Rwanda. The latter is one of the five province that make Rwanda. It is in the South of Rwanda and has a common border with Kigali City to the North, Eastern Province to the East, Western Province to the West and Burundi to the South. It has an area of over 5701 km² and a population of 2,589,975. Kabgayi District Hospital was chosen because, it is only one District hospital in Southern Province which provide general medical, surgical, pediatric, maternity, laboratory, pharmacy and TB follow up unit. There are around 400 healthcare personnel including doctors, nurses, social workers, and cleaners working in selected health units of the Hospital.

The sample size was calculated using Yamane formula 9 (n=N/1+N*e²) as the target population was less than 2000. After considering e at 5% margin of error and N target population of 400 healthcare personnel, the sample size calculated was 200 healthcare personnel. This study employed simple random sampling technique to select the respondents from each unit using the probability proportional to sample in each unit.

The highest percentage(39.0%) of respondents were aged between 35 and 45 years. Female healthcare personnel were dominant (56.0%). About half (47.0%) of respondents were married and the highest number (43.0%)were nurses. According to work experience, 47% of the respondents worked for 11-15 years. Of the 200 participants, majority (78%) had received training about waste management and 52% of them had training twice in a year (Table 1).

(Table 2) shows that more than half (52.0%) of respondents knew about bio-medical waste management process in the hospital. Of 200 participants 53.0%,61% and54.0% knew that HIV/AIDs, Hepatitis B and Hepatitis C can be transmitted through poor handling of bio-medical waste. Similarly, 37.0% knew that microwave can be used to handle bio-medical waste management, 51% knew that land can be used correctly to handle bio-medical waste. Most of the respondents 66.0% were aware that the universal precaution rule about bio-medical waste management. Majority (61.0%) also knew that the storage time for infectious waste can be 10 to11 minutes. The results show that nearly a half (49.0%) of respondents demonstrated a good knowledge about bio-medical waste management control.

Respondents were asked whether they use colour coding to dispose non-infectious wastes and only 22.0% use colour coding all the time. Out of 200 participants, more than half (53.0%) respondents use colour coding to dispose infectious waste, 55.5% segregate general waste from bio-medical waste, and 46.5% daily collect bio-medical waste and transport to the designated storage site. A total of 107(53.5%) temporary treat and dispose hospital waste for one day. Most(60.0%) were using weight handler and keep record of generated waste and 67.5%use wheeled for waste transport. The majority of respondents 66.5% use personal protective equipment(PPE) when handling bio-medical wastes. Regarding the compliance with safety precautions, the highest number (35.5%) always comply with safety precautions (Table 3).

Concerning the use of safe disposal of sharps, 42.5% always use safe disposal of sharps, 41.0% do it often while 16.5% do it sometimes. Respondents were also asked when they wear overall safety protection while handling wastes and about one third (36.5%) do it always. Regarding the types of PPE used by respondents, 39.0% always wear gloves, 43.0% always wear gowns, 69(34.5%) always wear caps, and 46.5% always wear masks when handling bio-medical waste. The highest percentage (35.5%) used to wash their hands always with bacterial acid agent after handling bio-medical waste. Regarding the overall practice score, only 33.5% demonstrated a good practice towards bio-medical waste management (Table 3).

The findings presented in Table 4 showed that age was the only demographic factor significantly associated withgood practices towards bio-medical waste management (p=0.007). Overall knowledge score about waste management was significantly associated with practices of bio-medical waste management (p=0.013) where most of respondents with good practices had good knowledge about bio-medical waste management (Table 4).

The overall objective of this study was to assess the knowledge and practice regarding bio-medical waste management among healthcare personnel at a District Hospital. A total of 200 healthcare personnel participated in the study. The findings from this study showed that about a half of respondents (49.0%)had good knowledge about bio-medical waste management process. This is in agreement to a study conducted in India among 100 nurses where 47% had excellent knowledge about bio-medical waste management11. Similarly, a study in Tanzania revealed that the knowledge level in management of medical waste was low among healthcare personnel12. However, the figure (49.0%) was low compared to the recent study conducted in Nigeria which reported that respondents in the various facilities had adequate knowledge of medical waste collection and handling 13. These difference could be probably the sample size and source of the target population.

The study revealed that 53.0% healthcare personnel use color coding to dispose infectious waste, 55.5% segregate general waste from bio-medical waste, and 46.5% daily collect bio-medical waste. These findings are supported by a systematic review of six studies which reported that color coding of wastes was not done by 67% of the subjects 14. Another study found that almost one out of every three respondents (35.7%) did not know that a symbol had been assigned to indicate bio-hazardous wastes. Another study also found that only 57.7% respondents were aware of all four color codes (Blue/White-Black-Red-Yellow) used for the bags into which bio-medical wastes are segregated 15. This shows that there is a need of refresher trainings to ensure sustainability and further improvement.

The overall practice in this study was very low where only 33.5% had good practice on bio-medical waste management. This was similar to the study done in Ethiopia which reported 31.5% 16. However, the result is lower than the study done in Pakistan where 94.3% of the study participants had adequate practice 17. This difference could be explained due to low enforcement or monitoring by the regulatory body in the health facilities.

Bio-medical waste management knowledge and bio-medical waste management practices were significantly associated in the present study where adequate practice was higher among respondents with good knowledge. This is similar to a study carried out in India, which revealed lack of knowledge about waste management significantly affects the safe practices for management 11. This demonstrates that improved knowledge can lead to as accepted practice. It is captivating to imagine a knowledge threshold where theoretical knowledge transcends into practice.

Among the socio-demographic factors, only age group was significantly associated with good practice of bio-medical waste management. The age group of 35 to 45 years had significantly more likely to exercise good practice compared to those aged between 18 to 25 years. This could be indirectly related to the years of experience as it is believed that increased experience will increase safer practices.