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American Journal of  Environmental
Economics (AJEE) 

Hospital Solid Waste Status: A Case Study of  Dosso Mother and Child 
Health Center (CSME) in Niger

Hassimi Moussa1*, Bachir Yaou Balarabe2, Laminou Manzo Ousmane3, Abdou Harouna4, Seydou Tahirou5

Volume 1 Issue 2, Year 2023
ISSN: 2833-7905 (Online)

DOI: https://doi.org/10.54536/ajee.v1i2.1069
https://journals.e-palli.com/home/index.php/ajee

Article Information ABSTRACT

Received: December 13, 2022

Accepted: December 29, 2022

Published: January 08, 2023

Thus, this study evaluated the solid waste management of  the mother and child health center 
(CSME) of  Dosso to contribute to its improvement. The approach involved conducting 
surveys and interviews, quantifying waste production, and analyzing how it is managed. 
According to the CSME Dosso hospital solid waste management analysis, all surface 
technicians were trained in hospital waste management, but 69% were illiterate. However, as 
part of  this management, 51 bins of  different capacities are set up for the entire establishment, 
including (18 bins with a capacity of  240 liters, 14 bins with 20 liters, and 19 small baskets 
with 10 liters). This characterization, based on both qualitative and quantitative measurements, 
indicates that Dosso CSME produces 167.63 kilograms of  waste per day, 58.67 tons of  waste 
per year, of  which 72% is waste that is risk-free, primarily waste. Approximately 28% of  waste, 
including household waste and containing infectious, toxic, and anatomical risks, is at risk. The 
disposal of  this produced waste is done either by burning, by landfilling, or by burial in pits 
dug without any standards. This management through these different stages constitutes a 
source of  environmental impact. This analysis also shows that the Dosso CSME needs a 
waste management plan and an operational incinerator, given the absence of  administrative 
regulations, unqualified technicians, and insufficient financial resources. 

Keywords

Health Center, Hospital Waste, 
Evaluation, Environment 
Management

1 Department of  Environmental Sciences, Faculty of  Agronomic Sciences, Boubakar Bâ University of  Tillabéri, Tillabéri-Niger
2 School of  Engineering and Technology, National Forensic Sciences University, Sector-09, Gandhinagar, India
3 Department of  Rural Engineering and Water & Forests, Faculty of  Agronomy and Environmental Sciences, Dan University  
  Dicko Dankoulodo from Maradi, Maradi-Niger
4  Department of  Animal Production and Nutrition, Faculty of  Agronomic Sciences, Boubakar BÂ University of  Tillabéri, Tillabéri-Niger
5  Aube Nouvelle University, Science and Technology Training and Research Unit (UFR/ST), Management Research and Studies  
  Laboratory (CREM) Ouagadougou-Burkina Fasow, India
* Corresponding author’s e-mail: atpscontact@gmail.com

INTRODUCTION
Hospital waste consists of  solid, liquid, or gaseous 
substances resulting from healthcare activities. They are 
a source of  environmental pollution and a vector for 
spreading a wide range of  diseases. (OMS, 2005). Even 
though they remain a serious public health issue, their 
management remains a concern of  politicians and the 
institutions that generate them. (OMS, 2005; Ndiaye et 
al., 2012). Despite efforts, most African countries have 
low levels of  hospital waste management (Abdelhak 
et al., 2019). A low-quality waste management system 
in hospitals is generally caused by a lack of  policy and 
reference documents, an absence of  resources, and poor 
institutional organization. (CICR, 2011; Metghari et al., 
2012). Health sector wastes have a significant impact on 
community and healthcare hygiene (Anonyme, 2007a). 
On the one hand, their management plays a crucial 
role in the quality of  care, in the safety of  patients and 
caregivers, and on the other hand, in the protection of  
the environment and the community from pollution 
and contamination (Maiboukar, 1999). Healthcare 
waste carries a higher risk of  infection and injury than 
household waste-like waste (Tesfahun et al., 2014). In this 
regard, they can be explained by the fact that they contain 
waste similar to household waste, sharp or pathological 
objects, infectious materials, pharmaceutical materials, 
medical devices, and radioactive materials. Many factors 
contribute to the generation of  hospital waste, including 
the social and economic condition of  patients, the 
type of  healthcare facilities, the hospital’s specialty, the 

waste sorting options available, seasonal variations, the 
number of  beds, and the number of  patients treated daily 
(Mahananda, 2015). A review by the WHO (2009) states 
that open waste can contain harmful microorganisms that 
can infect hospitalized patients, medical personnel, and 
the general public, hence the need to eliminate such waste 
safely. Based on their origin and the danger they pose 
to humans or the environment, waste can be classified 
(Topanou, 2012). Hospital waste can be divided into two 
categories: waste assimilated from household items and 
waste generated from healthcare activities. Healthcare 
waste consists of  potentially infectious and non-infectious 
wastes from a healthcare establishment (OMS, 2005). 
It is essential to understand that any waste similar to 
household waste becomes contaminated when it comes 
into contact with hazardous waste, either directly or when 
it is not packaged bacteriologically. Thus, hazardous waste 
can either be direct (depending on production) or indirect 
(contamination during collection). (Maystre et Duflon, 
1994; Maystre et Viret, 1995). WHO (2005) reports that 
60% to 64% of  health facilities in developing countries 
do not dispose of  waste according to recommended 
methods. The production of  biomedical waste in Mali is 
estimated at 1603 kilograms per day. In addition, 13.15 % 
of  the units practiced waste sorting, while 78.39% did not 
treat their waste (Rayanatou, 1999; Sanogo et al., 2007). 
According to Ndié et Yongsi (2016), 92% of  referral 
health facilities in Cameroon had poor hospital waste 
management. Since the last decades, Niger has improved 
its health coverage through the construction of  several 

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health facilities and the expansion of  existing structures. 
As a result, this sector produces a large quantity of  waste 
(PNGDISS, 2015). Microorganisms are concentrated in 
these wastes, resulting in environmental and atmospheric 
pollution (Yaya, 2011). As a result, poor management 
contributes to the spread of  infections both within 
and outside hospitals. Several scientific studies have 
shown that disposal of  solid hospital waste is not always 
satisfactory, especially in developing countries and Africa 
south of  the Sahara (Mohamed, 2008; David, 2004; 
Ndiaye et al., 2003). This led the Mother and Child Health 
Center (MCHC) in the Dosso Region of  the Republic 
of  Niger to become interested in managing solid hospital 
waste with the primary aim of  improving hospital waste 
disposal.

MATERIALS AND METHODS 
Dosso Mother and Child Health Center presentation 
In addition to providing gynecological-obstetric and 
postnatal care, the Dosso Mother and Child Health Center 
also offers family planning services. The center is located 
between latitude 3°.21’’ and longitude 13°.037’’ in the 
urban municipality of  Dosso. Approximately 4 hectares 
of  land are occupied by the hospital, which has 108 beds, 
including 96 functional beds in its various departments. 
The hospital has five (05) hospitalization departments 
(gynecology, obstetrics, pediatrics, CRENI), as well 
as seven (7) support services (Laboratory, Pharmacy, 
Medical Imaging, Maintenance, Hygiene/Sanitation) and 
ancillary services (Kitchen, Laundry, Morgue).

Study scope limitation
This study examined all possible hospital solid waste 
generation services offered by the center. The operating 
room, radiology, referral, laboratory, administrative block, 
social services, pharmacy, Gynecology, and Pediatrics 
A/B are among these facilities.

Sampling
Surveys were carried out during this study using a 
representative sample. The sample included doctors 
and majors in various departments, the head of  hygiene 
and sanitation, and laborers responsible for waste 
management. This individual-type survey questioned 
50 agents, including 24 medical and paramedical staff, 
25 surface technicians, and the head of  sanitation and 
hygiene.

The methodological approach
In this study, primary and secondary data were collected 
and analyzed using a qualitative and quantitative 
approach. The primary data was obtained by measuring 
the waste produced in various hospital departments. 
Wastes generated by infectious activities, chemical or 
toxic activities, household wastes, and anatomical wastes 
generated at various levels of  the CSME in Dosso were 
quantified. Afon et al. followed this methodology in 
their study (2017). Waste generated by each department 

was measured and recorded. For storage and weighing 
purposes, each cleaner received two (2) polythene 
bags per day. The polyethylene bags were measured on 
a calibrated spring scale of  10 kg±0.1 kg. A repeat of  
this experience took place every 24 hours for 10 days 
(August 28 through September 8, 2021). Secondary data 
was collected from agents using a questionnaire and 
field observations. Through direct observation, we could 
observe the waste produced in this establishment and 
gain a better understanding of  their waste management 
system (production, sorting, packaging, collection, 
storage, transportation, and disposal). Additionally, 
the data obtained included the number of  beds in the 
services, the number of  cleaners, and the number of  
waste managers. Cross-tabulations and graphs were used 
to analyze the collected data.

RESULTS AND DISCUSSION
Results
Human Resources
In addition to one sanitation and hygiene technician, 
there are twenty-five (25) surface technicians that collect 
solid waste within the Dosso CSME. In figure 1, surface 
technicians are grouped based on their level of  education. 
Most of  these technicians are housekeepers who maintain 
the cleanliness of  the course as well as the rooms for each 
service.

Figure 1: Education level distribution of  surface technicians

Based on Figure 1, it is evident that 69% of  surface 
technicians are illiterate, 12% are secondary educated, and 
19% are primary educated. Additionally, these technicians 
are categorized based on their level of  training in hospital 
waste management (Figure 2). The figure shows that all the 

Figure 2: A distribution of  surface technicians based on 
the level of  training they have received in hospital waste 
management

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surface technicians who were surveyed attended at least 
one training course in hospital solid waste management. 
This training course helped them to have the notions and 
skills necessary to manage solid hospital waste properly.

Waste storage
A central storage facility is located at the Dosso CSME 
for disposing of  waste before evacuation. Upon the 
arrival of  the town hall’s evacuation vehicle, hazardous 
waste and household waste are stored in bulk next to 
the burner. Infectious waste is burned before disposal. 
The site is compartmentalized according to the two types 
of  waste collected: infectious waste is burned before 
disposal.

The Estimated amount of  waste
Tables 1, 2, and 3 present the results of  quantifying solid 
waste in the hospital for all departments involved in this 
study. Table 1 shows the quantitative analysis of  infectious 
risk wastes from the 11 departments studied. Infectious 
risk activities average 3.13 kg per day (Laboratory) and 
8.25 kg per day (Operating Room). There is an average 
of  42.28 kilograms of  infectious risk activities evacuated 
from the departments studied every day. There is an 
average of  23.75 kg (Pediatrics A) to 4 kg (Radiology) 
per day in similar household waste, resulting in a total 
production of  124.69 kg (Tab2). Besides anatomical 
wastes (Table 3), chemical or toxic wastes were analyzed 
quantitatively. The radiology department recorded 17 

Table 1: Wastes with infectious risks (kg)
Services Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Daily 

Average
Gynecology 4,5 2 3 6 7 2 2,5 9 6 7,5 4,95
Obstetrics 6 4,5 6 11 3 1,5 3,5 7 4 4,5 5,1
Laboratory 3 2,5 1,5 3,5 4 2,8 3 4 2 5 3,13
Operating room 7 8 4 9,5 9 6,5 4,5 12 14,5 7,5 8,25
Referral 7 5 13 5 4,5 3 7 3,5 6
Pediatrics A 6 9 5,5 7 6,5 10 8 6 7,5 8 7,35
Pediatrics B 7,5 6 7 3,5 8 8,5 5 13 11 7,5 7,7
Total 41 37 40 45,5 42 34,3 26,5 51 52 43,5 42,28

Table 2: Similar to household waste, quantification (kg)
Services Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Daily 

Average
Gynecology 15 15 18 13 17 16 12,5 17 18 12,5 15,4
Obstetrics 28 22 37 4,5 17,5 19,5 18 24 20 23,5 21,4
Laboratory 8 6 5 7 4 3,5 2 7 9 7 5,85
Operating room 5 7 8 5 9 2 13 7 15 14,5 8,55
Referral 6,5 10 6 22,5 4,5 4,8 7 7 5,5 7 8,44
Radiology 4 4
Pharmacy 3,5 2 2 6 6,5 2,5 4,5 1,5 7 6 4,15
Administrative block 4,5 6 5,5 2 3,5 5 1,5 7 5 1,5 4,15
Social Service 6 11 7 3,5 7 3 7 12 7,5 4 6,8
Pediatrics A 21,5 17 25 27 22 32 23 19,5 20 30,5 23,75
Pediatrics B 25 28 21 22,5 14 18,5 15,5 24,5 26 27 22,2
Total 127 124 134,5 113 105 102 104 126,5 133 133,5 124,69

Table 3: Waste with toxic or chemical risks and anatomical waste quantification (kg)
Services Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Daily 

Average
Waste with toxic or chemical risks
Radiology 2,5 1,5 1 2,5 2 - - 4,5 1      2 2,5
Anatomical waste
Obstetrics 3,5 2 1,5 3,5 2,5 4,5 6 4 4,5      3 3,5

kg of  hazardous chemicals or toxic waste over ten (10) 
days, an average of  2.5 kg per day. An average of  3.5 
kg of  anatomical waste (placentas) is produced by the 
obstetrics department every day. According to the days of  
the week, Figure 3 summarizes the total daily production 
of  Waste with infectious risks and Similar to household 
waste. All waste categories are lower on Friday, Saturday, 
and Sunday than the rest of  the week. With a maximum 
recorded on Wednesday (134.5 kg), similar to household 

waste releases are greater than wastes with infectious risks 
during the week (daily production: 45.5kg). The minimum 
production is recorded on Sunday for both Wastes with 
infectious risks (26.5kg) and Similar to household waste 
(104kg). In addition, waste similar to household waste is 
produced in all departments, while infectious risk waste 
is absent from Radiology, the Administrative Block, 
Social Services, and Transfer Pharmacy. In Figure 4a, 
risk-free waste (waste similar to household waste) and 

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risk-based waste (waste with infectious or chemical risks 
or anatomical waste) represent respectively 72% and 
28% of  the center’s waste production. Figure shows 4b 
how hazardous waste is distributed in the center. A total 

of  87% of  the waste produced has an infectious risk. 
Infectious and anatomical waste accounted for 7% and 
6% of  the total waste, respectively.

Figure 3: Daily waste production (in kg)

Figure 4: (a)-Typology of  hospital waste from the Dosso CSME, (b)-Distribution of  hazardous waste from the 
Dosso CSME

DISCUSSION
From August 10 to November 10, 2020, this study 
occurred at the Dosso mother and child health center. 
In the study, 11 services at the center generated waste 
that was similar to household waste, infectious risk waste, 
chemical or toxic risk waste, and anatomical waste. As 
a result of  the coexistence of  administrative and care 
services in the center, this type of  waste is generated. 
According to WHO (2009) recommendations, healthcare 
facilities should have an appropriate management 
plan. Furthermore, the availability of  waste collection 
equipment enhances the safety of  healthcare waste 
management (OMS, 2005). At the Center, not only are 
the materials intended for waste management insufficient, 
but they also need to meet the standards set by WHO 
regarding adequate waste management. Since biomedical 
wastes are not sorted, all waste is classified as “a” waste 
at risk, increasing the risk of  contamination (Metghari et 
al., 2012). It is for this reason that sorting is so critical. 

The majority of  agents (74%), who were surveyed during 
this study, confirm the existence of  waste sorting at the 
source, in contrast to 28% who believe nurses do not 
respect it. Accordingly, field observations confirmed the 
existence of  this sorting in most departments, although 
not according to WHO standards, since the hazardous 
waste was often mixed with similar to household waste. 
It is apparent that hospital staff  are not trained in waste 
management, which explains the failures observed in 
waste management. The same observation was made 
in several African health structures (Adon, 2011, Koffi, 
2021). Quantification of  waste can be used to rationally 
estimate the required material and human resources and 
then develop a waste management plan tailored to each 
service’s requirements. As a result of  observations made 
in the field, waste can be divided into various categories, 
such as infectious waste (sharp or not), chemical waste, 
toxic waste, radioactive waste, and household waste. 
This is mainly due to the different healthcare services 

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the institution offers. An identical study conducted in 
Algeria (Abdelhak et al., 2019) found that infectious 
wastes, pharmaceutical wastes, household garbage 
wastes, anatomical wastes, and radioactive wastes were 
most prevalent at the level of  the health sector in Sidi Bel 
Abbes. Most of  the waste generated by Dosso CSME is 
similar to household waste, while 28% is specific to its 
activities. According to the World Health Organization, 
hazardous waste should not account for more than 10 to 
15% of  the total waste produced in healthcare facilities. 
A study conducted by Koffi et al., (2021) found lower 
rates at the Daloa Regional Hospital Center in Côte 
d’Ivoire. However, it is not uncommon for fractions of  
waste similar to household waste to be found in the bins 
designated for waste specific to a care activity. It appears 
that hospital waste management at the CSME in Dosso 
still needs to be improved. In total, 1729.7 kg of  solid 
hospital waste is generated per day at the Dosso CSME, 
which is 5.2 t/month. From this, we can conclude that 
the Dosso CSME produces 62.3 t/year of  solid hospital 
waste. Based on the results of  a study conducted at the 
EL KHROUB Hospital in the wilaya of  Constantine, 
Sedrati and Sebti (2017) found a quantity of  146.27 
kg/d, or 51.19 tons per year. Nevertheless, this amount is 
negligible compared to the volume of  waste produced at 
the Lamordé National Hospital (HNL) in Niamey, which 
is 329.87 t/year. Because public hospitals receive high 
attendance every day and have a relatively high staffing 
level, this makes sense. There are a number of  stages 
involved in hospital waste management, from production 
to final disposal. The disposal of  hospital waste from 
the Dosso CSME leads to pollution of  water, air, soil, 
and health, including puncture wounds, infections, and 
intoxication of  collectors. According to Jean-Paul (2017), 
the Paul VI Surgical Medical Center’s waste management 
also has an environmental and health impact. In the study, 
67.66% of  personnel had been stung, 14.71 % suffered 
from musculoskeletal disorders, 5.88% had suffered 
cuts, and 2.94% had been irritated by eyes; on the other 
hand, there is pollution in the atmosphere with 7.549 t 
of  greenhouse gases, soil pollution, and water pollution.

CONCLUSION
A study at the CSME of  Dosso was conducted to 
evaluate the ongoing management of  hospital solid 
waste. According to the data obtained, the CSME of  
Dosso does not have an incinerator or a guide that would 
allow rational waste management. Surface technicians 
are trained in managing biomedical waste, but 69% 
are illiterate. Biomedical waste is usually treated in situ 
by burning and burying. It is pertinent to recognize 
that this is an influential factor that can influence the 
effectiveness of  these agents in managing hospital waste. 
Hospital waste management is associated with several 
risks, but the lack of  monitoring (rewards or sanctions) 
of  activities explains the difficulties in sorting, collection 
frequency, and external transportation. There are two 
types of  waste that Dosso CSME produces: risk-free 

waste (waste that is similar to household waste) and risk 
waste (waste that is potentially infectious, chemically or 
toxically hazardous, or anatomically hazardous). Dosso’s 
CSME is limited in terms of  managing solid hospital 
waste as a result of  regulatory, organizational, technical, 
and financial constraints. Managing this effectively 
requires collaboration, coordination, and harmonious 
participation from management at all levels. To remove 
these constraints, waste management plans outline the 
objectives, activities, stakeholders, resources, monitoring, 
supervision, and control mechanisms. The liquid waste 
generated by the Dosso CSME was not considered 
in this study. A diagnosis of  the CSME’s liquid waste 
management system would be an exciting aspect of  this 
study.

Acknowledgments 
The authors would like to extend their appreciation to 
the Department of  Environmental Sciences, Faculty of  
Agronomic Sciences, Boubakar Bâ University of  Tillaberi.

Conflict of  interest
The authors have declared no conflict of  interest.

Funding 
This study was supported by the Department of  
Environmental Sciences, Faculty of  Agronomic Sciences, 
Boubakar Bâ University of  Tillaberi.

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