Travail de recherche personnel

Abstract

The health sector contributes substantially to global greenhouse gas emissions while directly bearing the health consequences of climate change. In Dakar, the capital of Senegal, biomedical waste management and dependence on fossil fuels pose significant environmental challenges, while the knowledge, attitudes and practices of health professionals regarding the environmental sustainability of care had, until now, not been documented there. This cross-sectional study, both descriptive and analytical, also included a geographic component. Conducted between March and May 2026, it involved 415 health professionals from the Dakar health region, recruited through purposive sampling followed by the snowball method. Participants completed a self-administered questionnaire, adapted from an instrument already validated in Southern Africa. This questionnaire covered three dimensions : knowledge, attitudes and practices, as well as perceived barriers to adopting sustainable practices. Reported sustainable practices were mostly at a satisfactory level (mean of 74.6%), knowledge was at an intermediate but dispersed level (mean of 70.6%), while the attitude scale showed negative internal consistency, warranting a cautious interpretation of this dimension. A near-null association was observed between attitudes and practices (Spearman coefficient = 0.05), a finding whose exact magnitude remains uncertain given the psychometric failure of the attitude scale (alpha = -0.009), while training received emerged as the most robust determinant of satisfactory practices, its effect operating mainly through a direct pathway rather than through transmitted knowledge. Institutional barriers, lack of directives and lack of incentives, largely dominated individual barriers. No spatial dependence, global or local, was detected between neighbouring facilities after correction for multiple comparisons. These results suggest that improving sustainable practices in Dakar's health facilities depends less on a deficit of individual awareness than on a deficit of governance and institutional framing.