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*Corresponding author:
Email: danielfitamo@gmail.com, +251-911996720 https://dx.doi.org/10.4314/eajbcs.v4i2.2S

Assessment of Healthcare Solid Waste Composition, Generation and its Management: the case
of Two Hospitals of Shashemene Town, Oromia Regional State, Ethiopia

Gudeta Elie, Daniel Fitamo and Semere Gebreaegawi*

Department of Biology, Hawassa University, Ethiopia

KEYWORDS:

Health care waste;
General Waste;
Hazardous Waste;
HCW Management;
Solid Waste Generation

ABSTRACT

Hazardous wastes from Hospitals could pose threat to the health of healthcare workers, the
general public and the environment unless managed properly. The study aimed to appraise
the healthcare waste (HCW) composition, generation rate and the prevailing management
practices in two Hospitals (a Private and a Government owned) of Shashemene Town,
Ethiopia. A cross-sectional study involving Direct Observation, Key Informant Interview,
Questionnaire survey and Weighting Scale was conducted to evaluate the current HCW
management practices and to quantify the HCW generation rate. Data was analyzed using
SPSS version 20. The mean generation rates of HCW were 45.2 ± 5.8kg day–1 (0.20kg
bed‒1day‒1) and 20 ± 2.4 kg day–1 (0.19kg bed‒1day‒1) from Government Hospital
(GH) and Private Hospital (PH), respectively. Of the total solid waste generated, over half
(GH: 53.3%; PH: 57.1%) constituted general waste (GW), and the remaining (GH: 46.7%;
PH: 42.9%) comprised hazardous waste (HW), which exceeded the WHO threshold
(10‒25%) intimates the lack of poor waste segregation. There were significant variations
between the hospital wards regarding GW (GH: χ2 = 31; P < 0.001; PH:χ2 = 13; P <
0.01), HW (GH: χ2 = 25; P < 0.001; PH: χ2 = 10; P < 0.01), and total HCW (GH: χ2 = 46;
P < 0.01; PH: χ2 = 22; P < 0.01). Besides, significant differences were observed between
the mean total HCW (χ2 = 9.016;P < 0.01), GW (χ2 = 9.8; P < 0.01) and the HW (χ2 =
5.011, P < 0.05) of the hospitals. Segregation of wastes and pre-treatment of infectious
wastes were not properly practiced, and single chamber incinerators was the most utilized
treatment method indicating poor management of the HCW. The study establishes that the
little attention is given to medical waste management which primarily proceeds from a
lack of due implementation of the national healthcare wastes management
guideline/directive at the healthcare facility level. If the poor healthcare solid waste
management is not properly addressed at the study hospitals, human (healthcare workers,
waste handlers, patients, and nearby community) and environmental health risk will be
within the bounds of possibility.

INTRODUCTION

Healthcare activities are means of protecting
health, curing patients, and saving lives
(Debere et al., 2013). Hospitals are among the

complex institutions which generate a broad
range of hazardous waste materials in the
course of healthcare activities (Farzadkia et
al., 2009). Healthcare waste is a major
problem in most developing countries of the
world due to its growing and endless

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Research article



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

14

generation coupled with poor management
(Abd El-Salam, 2010). Healthcare waste
contains a large component (75‒90%) of non-
risk or general healthcare waste, comparable
to Municipal Solid Waste (MSW) and a
smaller component (10‒25%) of hazardous
waste may  pose a variety of  health  risks
(WHO, 2014).

The process of collecting, storing,
transporting, treating and disposing waste
material is known as waste management (Al-
Khatib and Sato, 2009). Improper waste
management in which the infectious waste is
mixed with the general waste can lead to the
entire bulk of the wastes becoming potentially
infectious. It is well known that inappropriate
hospital waste management is pressing both
health hazards and environmental pollution,
facing many healthcare centers of this
developing world (Bdour et al., 2007).
Diseases like Cholera, Dysentery, Skin
Infection, and Infectious Hepatitis can spread
epidemic way due to the mismanagement of
hospital solid waste (Coker et al., 2009).
Therefore, it is urgent to determine
appropriate methods for the safe management
of hospital solid waste.

Uncontrolled combustion of medical waste
accounted for 26% of the annual total Dioxins
/ Furans release in 2003 in Ethiopia (EEPA,
2006). Recently, considerable gap exists with
regard to the assessment of healthcare solid
waste management practices in Ethiopia.
Unfortunately, relevant information on this
important aspect of healthcare management is
inadequate and research on the public health
implications of inadequate management of
healthcare solid wastes are few in  number and
limited in scope (Habtetsion et al., 2009).

Ethiopia is signatory to the  Stockholm
Convention  on  Persistent  Organic
Pollutants (POPs), which is a global
convention  with  the  aim  of  eliminating
some  of  the  most long‐lived anthropogenic
pollutants (UNEP, 2009). While studies
illustrate the solid waste menace in the
Ethiopian towns and cities, the data on health
care solid waste remains in huge paucity both
at regional and national level. The present
study, therefore, attempted to determine the
healthcare solid waste composition, generation
rate as well as evaluate its management
systems in two selected hospitals of
Shashemene town, Oromia region

MATERIALS AND METHODS

Description of the Study Area

Shashemene town is the capital of
Shashemene Woreda (District) in West Arsi
Zone of Oromia Regional state, Ethiopia. It
lies on the Trans-African highway of Cairo-
Cape Town, about 250 km from the capital of
Addis Ababa. The town is located at Latitude
of 7° 12' North and a Longitude of 38° 36'
East. In Shashemene Woreda, there are
Teaching and Referral (Shashemene Referral
Hospital), and Private (Feya General Hospital)
Hospitals providing services for more than
122,046 people. Shashemene Referral
Hospital has a total of 240 beds with an
average patient’s flow of 282 patients/day
providing Cafeteria, Emergency, General
Medicine, Family Planning, Laboratory,
Leprosy, TB and Malnutrition, Epilepsy and
Psychiatry, Ophthalmic, Pediatrics, Surgical,
Pharmacy, and Inpatient Services. Feya
General Hospital is private owned hospital
and the hospital is engaged in providing



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

15

diagnostic and medical treatment in addition
to providing other routine services, such as
Out-Patient, Laboratory Services, Pharmacy
Services, Emergency, Delivery, Family

Planning, and Voluntary Counseling and
Testing services etc. The Feya General
Hospital accommodates a total of 150 beds
with average patients/flow of 98 patients/day.

Figure. 1 Geographical map of Ethiopia and Oromia region showing map of the study area
(Shashemene town)

The Study Design

It entailed a hospital-based cross-sectional
study to evaluate the waste generation rate and
its management system in the two hospitals of
Shashemene town. The study was conducted
in three phases (3 weeks of study). During the
first week, a trial collection exercise was
conducted before initiation of the regular
collection program. The purpose of the first
phase (i.e., first week of the study) was to
identify the main waste types and
characteristics, learn the skills of determining
the respective quantities generated from the
different departments/Case Teams and plan
the daily collection and segregation of waste

during the study period. The center of the 2nd

phase of study was the management of
hospital solid waste while the nub of the 3rd

phase was determining the amount of waste
generated. In the latter two phases (phase 2
and 3), waste collection and measurement
took place for seven consecutive working
days. The proposed indicator for the
evaluation of hospitals waste management was
a daily generated amount of healthcare waste
to one bed (general waste per bed per day and
hazardous waste per bed per day).

Determination of Sample Size

A stratified random sampling method was
used to select the required categories of health



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16

professionals. A random sample is one in
which every element in the population has an
equal and independent chance of being
selected from the sample (Crowther and
Lancaster, 2009). The total population size
(N) of the two Hospitals was 130, which
comprise 75 nursing staffs, 33 medical staffs,
and 22 other health and support staffs. This
was pooled from government hospital (with
18 medical staff, 50 nursing staff and 12 other
health staff) and private hospital (15 medical
staff, 25 nursing staffs and 10 other health
staff).

The sample size (n) was determined using the

Slovin Formula

where n = Number of samples, N = Total
population and E = Error tolerance (level).

Accordingly, the sample size required for the
study was calculated to be 98respondents from
both hospitals. When fractionated based on
proportional allocation, the sample size is
constituted of 25medical staffs (15 from
Government, and 10 from Private), 56 nursing
staffs (35 from Government, and 21 from
Private), and 17other health staffs (10 from
Government, and 7 from Private).

Data Collection

The method adopted for this study follows the
procedure used by Longe and Williams
(2006). Accordingly, data collection tools
involved questionnaire survey, site visitation
(personal observation) and Key Informant
Interview. The key informants were
purposively selected and includes heath care
directors, experts and policy developers in the
zone. Both the key informant interview and

the Direct Observations were conducted by
principal investigators while the
questionnaires were administered subsequent
to the translation (from English) to the local
language of the study area (Afan Oromo). The
site visit was conducted by using checklist to
review the segregation, handling, collection
and storage practices at the various case teams
of the study hospitals.

Plastic polyethylene bags and labeled color
coded waste containers were used for
collection of solid waste from ward,
laboratory and departments of the hospitals.
The solid waste was manually separated
(following appropriate safety precautions) into
two categories such as Hazardous and Non-
Hazardous as designated in WHO guideline
(WHO, 1999). Electronic balance, calculator
and recording forms were used for solid waste
measurement and recording. Waste generation
per day was determined by taking the fraction
of the Total Waste produced over the study
duration by the length of the study period (7
days) in kg day–1. The solid waste generation
can be computed by dividing the total weight
of waste (in kg) generated per day with the
number of beds in the hospital (i.e., the vacant
beds were not considered) expressed as
kg/bed/day or dividing the total weight of
waste (in kg) generated per day with number
of inpatients attended daily in the hospital
expressed as kg/patient/day (Kagonji and
Manyele, 2011). Likewise, Alagha et al.
(2018) stated that a universal indicator of
Medical Waste (MW) generation is the weight
of Healthcare Waste generated per bed per day
(kg bed–1 day–1) for a given medical facility.
Accordingly, waste generation per (occupied)
bed per day was calculated as given below:



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17

Wbd = [MW weight (kg)]/[(day) × (Bed)]
where Wbd, is defined as the total weight
of MW (in kg) generated per occupied bed
per day.

Data Analysis

The data was entered into spread sheet of
Microsoft Excel and exported to Statistical
Package for Social Sciences (SPSS version
20) for analysis. For testing the Bi-Variate
association between Hazardous Waste
generated, Patient Flow, and Occupied Beds
in study Hospitals, Spearman’s Rank
Correlation (rs) was computed following
Gerald et al. (2004). Healthcare Waste (HCW)
generation rate and categories of HCW among
the different Case Teams in each Hospital
were compared using Kruskal-Wallis-test as
indicated in Gerald et al. (2004). Data from
Key Informant Interviews and Direct
Observation were analyzed by theme and the
content analysis was made manually, by
sorting the organized information according to
thematic similarities and differences. P-value
and rs was reported to present the extent of
strength in terms of significant variation and
association between two variables, in that
order. In all the analysis, level of significance
was set at P< 0.05.

RESULTS AND DISCUSSION

Healthcare Solid Waste Management
Practice

Healthcare Solid Waste Segregation

In general, there is poor segregation of
hazardous solid wastes even though the
hospitals employ separate receptacles/bins.

Besides, as reported by Katusiime (2018),
Non-Hazardous Wastes (NHWs)/General
Wastes (GWs) were often mixed with
infectious wastes in the Government Hospital
(GH). Notwithstanding this, both hospitals
employed specific/separate bins for the
collection of infectious wastes, and sharp
wastes were collected in puncture proof safety
boxes. Conversely, the hospital solid waste
segregation practiced in Private Hospital (PH)
was relatively better than the same for the GH.
In similar vein, lack of proper HCW
segregation in Ethiopia was reported by
Tesfahun (2015), Hayleeyesus and Cherinet
(2016), Meleko and Adane (2018), and Yazie
et al. (2019). In Urban Referral Hospital in
Uganda, Katusiime (2018) also reported that
though waste was generally discarded in large
waste bins and sharps in separate sharps
containers, the notion of waste segregation
was non-existent. On the other hand, as with
Tesfahun (2015), the reuse and recycling
practice of the NHWs were almost absent in
both hospitals; in the GH, however, it was
observed that there was some reuse of drug
containers (e.g., cans, plastic and bottles)
without any precautions. Similarly, Meleko
and Adane (2018) found that there were no
any observed activities performed by health
professionals or other staff to reuse or recycle
materials.

In the PH, healthcare solid wastes were
merely segregated into infectious, sharps and
pathological wastes whereas in GH the
segregation was almost absent except the
segregation of sharp waste using the safety
box. On the other hand, placentas and blood
stained cotton pads were kept in separate
containers in PH. In the GH, in contrast,
anatomical wastes are collected with wound



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18

dressings, placentas and blood/fluid-stained
pads in a receptacle outside the wards (Figure.
2d). On the other hand, the use of waste
containers with a color code and labelling at
the point of generation was implemented in
both hospitals. However, it was observed in
GH that some receptacles with different color-
codes were observed and, hence a color code-
label mismatch was practiced (e.g., Blue and
Green plastic bins were employed for
Infectious Wastes and Non-Infectious Wastes,
respectively) (Figure. 3). Yazie et al. (2019) in
their review of studies conducted on Ethiopian
Hospitals indicated that there was no use of

proper color-coded bins for waste segregation.
This may result in hazardous wastes not only
being disposed inappropriately, but also with
members of the community gaining access to
such wastes. Similar non-compliance had been
reported in primary healthcare centers
assessments conducted in several developing
countries such as Laos, Turkey, Mongolia,
among others (Yong et al., 2009; Sanida et al.,
2010). Consequently, as to Katusiime (2018),
this will inevitably increase health risks to
health workers, waste disposal workers, and
the public. generation.

Figure 2. Waste collection and storage systems near the beds (a and b), in corridors (c), outside
wards (d) in the Government Hospital, Shashemene, Ethiopia

Figure 3. Cases where there were Color Code–Label Mismatches in the Government Hospital

On the other hand, only 25% of the
respondents from GH acknowledged that the
wastes were segregated at the point of

generation while 50% of the study participants
from PH expressed recognition of the practice
of segregation at the place of generation



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19

(Table 1). Waste is segregated depending on
the quantity, composition, and the disposal
method of the waste stream (Shareefdeen,
2012). The present finding was similar with a
finding obtained in Addis Ababa (Ethiopia)
where almost all of assessed hospitals reported
that there was no segregation of wastes and,

had no separate bins for the collection
infectious waste (Debere et al., 2013). As to
WHO (2014), segregation of solid wastes
should be performed by the producer of the
waste as close as possible to its place of
generation.

Figure 4. Waste collection and storage systems near the beds (a and b), outside the bed rooms
(i.e., in corridors) (c), outside the wards (d) in the Private Hospital, Shashemene, Ethiopia

Healthcare Solid Waste Collection, Interim-
Storage and Transport

The arrangements of hospital solid waste
collections and storages adjacent to the bed, in
the corridor, and outside the wards are
presented in Figures 2 and 4. In GH, solid
waste generated was usually deposited into the
small open plastic bins and open drug cartons
close to the bedside, which ultimately produce
unhygienic condition near the bed (Figures 2a
and b). Conversely, in PH, the solid waste
generated in similar location is collected in
partially closed receptacles/bins placed away
from each bed (Figure 4a and b).

All wards of the GH use substandard dustbins
storages, such as trash bags, plastic buckets
and drug cartons (that can be easily damaged)
to store HCW temporarily in open for about
12–24 hours (Figure 2). In Government
Hospitals, Tayework (2016) reported that all
hospital solid wastes were temporarily stored
in open and substandard dust bins for about

unlimited time. The data presented in Table 1
shows that 75% of the respondents from GH
indicated that the wastes were collected once
per day. Conversely, in PH, colored plastic
bins were placed in the designated place
(Figure 4a) in each room while leak-proof
containers made from stainless steel were
placed outside the rooms (Figure 4d). Besides,
in PH, healthcare waste was collected on daily
basis by cleaning personnel and transported to
the on-site handling area. As to the
information displayed in the Table 1, 40% and
60% of the respondents from PH laid out that
the wastes were collected once and twice a
day, in that order. In all studied healthcare
facilities, Hayleeyesus and Cherinet (2016)
reported that HCW is collected on a daily
basis by cleaning personnel and transported to
an on-site handling area. On the other hand, in
both hospitals, only Pathological and Sharp
Wastes were collected, stored and transported
in closed plastic buckets/containers within an
hour. On the contrary to other Hazardous
Wastes (HWs) like potentially infectious and



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20

sharp wastes were collected in puncture-proof
containers (Safety Boxes) in both hospitals
(Figures 2 and 3a). As to WHO (2014),
collection times should be fixed and
appropriate to the quantity of waste produced

in each area of the healthcare facility and
recommends that collection should be carried
out daily for most wastes, with collection
timed to match the pattern of waste generation
during the day.

Table 1. Participants’ response on the waste collection, treatment and disposal practices at the
surveyed hospitals

Question Response Hospital
Government Private

Do you segregate waste at the point of
generation?

Yes
No
I don’t know

3(25%)
7(58.3%)
2(16.7%)

5(50%)
4(40%)
1(10%)

Do you use gloves, boots, masks & caps when
handling HCW?

Yes
No

3(25%)
9(75%)

4(40%)
6(60%)

On-site handling (patient’s bed to storage
place)

Once per day
Twice per day
Irregular

7(58.3%)
1(8.4%)
4(33.3%)

5(50%)
3(30%)
2(20%)

On-site handling (storage place to final
disposal)

Once per day
Twice per day
Irregular

9(75%)
1(8.3%)
2(16.7%)

4(40%)
6(60%)
0(0%)

Bags were filled with more than ¾ (75%) Yes
No
I don’t know

7(58.3%)
3(25%)
2(16.7%)

6(60%)
4(40%)
0(0%)

The filled bags were closed tightly before
transferred

Yes
No
I don’t know

6(50%)
2(16.7%)
4(33.3%)

5(50%)
2(20%)
3(30%)

The filled bags were replaced with empty one
at the same time of discharge

Yes
No

5(41.7%)
7(58.3%)

7(70%)
3(30%)

Vessel used for the transport of a sharp waste
was perforated

Yes
No

8(66.7%)
4(33.3%)

2(20%)
8(80%)

Waste treatment method used Incineration
Open burning
Burial

9(75%)
2(16.7%)
1(8.3%)

6(60%)
2(20%)
2(20%)

Do you treat hazardous HCW differently from
general waste?

Yes
No
I don’t know

5(41.7%)
3(25%)
4(33.3%)

7(70%)
2(20%)
1(10%)

From PH and GH involved in the present
study, only 40% and 25% of the respondents,

respectively, indicated that waste bags and
sharp containers were filled to ¾ full (Table
1). Waste bags and sharps containers should



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21

be filled to no more than three quarters full
and once this level is reached, they should be
sealed ready for collection (WHO, 2014). On
the other hand, 70% and 41.7% of the
participants from PH and GH, respectively,
made known that the filled bags were replaced
with empty one during waste collection (Table
1). Replacement bags or containers should be
obtainable at each waste-collection location so
that full ones can immediately be replaced
(WHO, 2014).

As with Tesfahun (2015), Tayework (2016)
and Meleko and Adane (2018), both hospitals
lack of proper and purpose-built waste storage
rooms; however, there was a temporary waste
storage room for pharmaceutical wastes in the
PH. Conversely, similar to the findings
reported by Meleko and Adane (2018), both
hospitals employ interim waste storage
(plastic bucket) outside the wards; wastes
were stored for 24‒36 and 12‒24 hours in the
GH (Figure 2d) and PH (Figure 4d) Hospitals,
respectively. Debere et al. (2013) observed
that hospital solid wastes were stored in
temporary storage area from 2 weeks up to
one month before final disposal.

On the other hand, in both hospitals, the
Janitors handle the HWs without wearing
Personal Protective Equipment (PPE) and
empty (discard) the smaller containers into the
larger ones which are placed in the corridors
and outside the door. Accordingly, 75% and
60% of the respondents from GH and PH, in
that order, revealed that the waste handlers did
not employ PPE while managing of the

wastes. In a similar study by Meleko and
Adane (2018), only about 24% of the waste
collectors/waste handlers had worn glove and
boots during waste collection and
transportation of healthcare wastes. In their
study on the East and West Kumbo health
districts of Cameroon, Dzekashu et al. (2017)
found that the use of PPE like Gloves (100%)
were the most common practice by waste
handlers, followed by Aprons (85.2%) and
Boots (55.6%).

In GH, HWs and NHWs were mixed outside
each room (Figure 2d), and transported to
incineration area using wheeled
trolleys/handcart (Figure 5a), waste bags
(carrying the same by their hands, on their
shoulders, or using pushcarts) (Figures 5a and
b). Although the transport of HCWs in the PH
was comparatively better and principally
involved wheeled trolleys/carts (Figure. 5c
and d), the same appeared not to be
appropriately sized according to the volumes
of waste generated at a health-care facility.
Moreover, during the transport of the solid
wastes from the interim storage receptacles to
the treatment area within the hospital premises
could entail the possibility of infectious waste
droppings on the walkways (Figure 5).
Awodele et al. (2016) indicated that wheel
barrows and trolleys comprised the major
means of evacuating the waste whereas
Dzekashu et al. (2017) observed that
transportation of medical waste was virtually
(96.7%) executed by lifting, and only 3.3% of
the health facilities employed trolleys for
transporting wastes.0.05).



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Figure 5. Healthcare solid waste transport in the Government (a, b) and Private (c, d)
Hospitals

Healthcare Solid Waste Treatment and
Disposal Practice

In both hospitals, waste storage and
transporting plastic buckets were not treated
with disinfectants as suggested by WHO
(2014). Besides, as with Tesfahun (2015),
none of the hospitals practiced pre-treatment
of highly infectious waste. However, the
Laboratory Department of the PH treated
infectious waste (including Cultures and
Stocks, Sharps, materials contaminated with
Blood, etc.) by autoclave machine.
Conversely, 41.7% and 70% of the
respondents from GH and PH, respectively,
maintained the belief that HWs should be
treated differently from GWs (Table 1).  The
existing methods employed to treat solid
wastes by both hospitals, in their order of
importance, were Incineration (brick-made to
burn sharp wastes), Open Burning, and Burial
(Table 1). As a rule, the choice of treatment
system involves consideration of waste
characteristics, technology capabilities and
requirements, environmental and safety
factors, and costs – many of which depend on
local conditions (WHO, 2014).

In GH, there was construction of new
incinerator for treatment at the time of study
because the former one became out of use due
to unavailability of gas connection, old and
filled with ash (Figure 6a). Consequently, the
partially burned healthcare solid waste was
further burnt and disposed of in an open pit
within the GH (Figure 6b and c). In the PH,
conversely, the incinerator was not only
properly functioning as depicted by
incomplete burning of waste (Figure 7a and
b), but also was located close by the
residential area of the medical staff within the
hospital premises. Consequently, apart from
failure to significantly reduce the volume of
treated waste, incinerators of both hospitals
generated a plume of smoke to their
immediate environments. The use of low
combustion single-chamber incinerators for
the treatment of healthcare waste was against
the Stockholm Convection on Persistent
Organic Pollutants (POPs) (UNEP, 2009)
since such incinerators release air pollutants to
the environment (Diaz et al., 2005).

On the other hand, both hospitals had an open
hand dug pit in their backyard that was used
for the open burning and direct dumping of
GWs. While the GH had an open placental pit
for disposal of pathological and anatomical



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23

waste generated from the delivery and
operation rooms (Figure. 6d), the PH
employed one closed placental pit (Figure. 7c)
and two closed ash pits. As with the case
reported by Meleko and Adane (2018), HCWs
in both hospitals were not disposed of in
appropriate sealed and labeled containers.
Such malpractices were also reported in Jos
Metropolis, Nigeria (Ndidi et al., 2009).

Generally, each component of HCW
management practices in both surveyed
hospitals did not conform to the Ethiopian
National Healthcare Waste Management
Guideline. Such poor HCW management were
also reported in similar studies conducted in
Nigeria (Di Bella et al., 2012), South Africa
(Nemathaga et al., 2008), and Iran (De Titto et
al., 2012).

Figure 6. Solid waste treatment methods: (a) Incineration, (b and c) open burning at waste
dump site and (d) Anatomical, Pathological and Placental burial pits in the Government
Hospital of Shashemene town.

Figure 7. Solid waste treatment methods: Incineration (a and b), and (c) Anatomical,
Pathological and Placental pit employed in the Private Hospital

Waste Generation and Characterization

The total weight of HCW generated in GH
and PH in Shashemene town were 316.5

kgweek–1 and 140 kg week–1, respectively.
Conversely, an average total of 45.2 ±
5.8kgday–1(0.20kg bed‒1day‒1) of HCW was
generated from GH whereas only below half



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24

as much (20 ± 2.4kg day–1 or 0.19kg
bed‒1day‒1) of the same was produced from
PH (Tables 2, 3, and 4). Although the above
generation rate was somehow comparable to
0.164 kg bed‒1day‒1 reported by Meleko and
Adane (2018), the same was lower than a
result obtained in Ethiopia (1.5kgbed‒1day‒1:
Tesfahun, 2015), Bangladesh
(1.24kgbed‒1day‒1: Hassan et al., 2008), Egypt
(1.03kgbed‒1day‒1: Shouman et al., 2013) and
France (3.3kgbed‒1day‒1: Windfeld and
Brooks, 2015). Variations in waste generation
hinges on the type or level of healthcare
facility (WHO, 1999; Bdour et al., 2007;

Haylamicheal et al., 2011; WHO, 2014),
hospital specializations (WHO, 1999),
location (Rural or Urban) (WHO, 2014),
established waste management methods,
proportion of reusable items employed in
healthcare facilities (WHO, 1999; Bdour et
al., 2007; Haylamicheal et al., 2011), level of
activity (number of occupied beds, number of
patients per day, and/or number of staff), type
of department, temporal variations (e.g.
weekday versus weekend, seasonal), and level
of infrastructure development of the country
(Bdour et al., 2007; Haylamicheal et al., 2011;
WHO, 2014).

Table 2. Distribution and healthcare solid waste generation rates by point source and type in
Government Hospital of Shashemene

Government
Hospital

Non-
Hazardous
Waste
(Kg
week–1)

Hazardous Waste
(Kg week–1)

Total
Hospital
Waste
(Kg
Week–1)

Percentage
of Total
Hospital
Waste (%)

Average
Daily
Hospital
Waste (Kg
Day–1)

IW PhW SW* PaW

OPD 30.3 5.9 14 0.6 7.0 57.8 18 8.3

Surgical 27.9 4.7 3.9 1.5 - 38 12 5.4

Pediatrics 20.4 7.3 3.5 4.7 8.1 44 14 6.3

Obs/Gyn. 16.5 9 9 5.2 10.2 49.9 16 7.1

Medical 27.6 10.5 2.4 1.6 3.1 45.2 14 6.5

Laboratory 15.9 5.5 8.9 2.7 9.1 42.1 13 6.0

Emergency 30 4.2 - 3.2 2.1 39.5 13 5.7

Total (Kg week–1) 168 47.1 41.7 19.5 39.6 316.5 100

45.2 ± 5.8
Mean ±  SD (Kg
Day–1)

24.1 ± 6.3 6.7 ±
2.3

6.0 ±
4.8

2.8 ±
1.7

5.7 ±
3.9 45.2 ± 5.8 -

% wt. by Type 53.3 14.8 13.2 6.2 12.5 100 -
IW = Infectious Waste; PhW: Pharmaceutical Waste; SW: Sharp Waste; PaW: Pathological Waste
*Includes Needles, Blades, Lancet Needles, Syringes, and Scalpel Blades

Of the total waste generated in GH, 53.3%
(24.1 ± 6.3 kg day–1 or 0.1 kg bed‒1day‒1) was
GW while 46.7% (21.1 ±3.2 kg day–1 or
0.091kg bed‒1day‒1) was HW (Tables 2 and
4). Equally, of the total waste generated in PH,

57.1% (11.4 ± 2 kg day–1 or 0.11 kg
bed‒1day‒1) was GW whereas 42.9% (8.6 ±
1.3 kg day–1 or 0.079 kg bed‒1day‒1) was HW
(Tables 3 and 4). A little over half of the total
HCW generated from the study hospitals (GH:



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

25

53.3%; PH: 57.1%) constituted GW. Meleko
and Adane (2018) reported that 0.091 kg /bed/
day (55.5%) was GW and the remaining 0.073
kg/bed/day (44.5%) was HW. Likewise, in
similar studies conducted in Ethiopia, Azage
and Kumie (2010), Debere et al. (2013), and
Hayleeyesus and Cherinete (2016) the GW
accounted for the 52, 58.69, and 65.1% of the
total HCW. Moreover, the result of the present
study is comparable with a results obtained
from healthcare facilities in Ethiopia where
48% (Azage and Kumie, 2010), 41.31%
(Debere et al., 2013), and 42.1% (Meleko and
Adane, 2018) of HCW were HW. Conversely,
the present finding was much bigger than a
result identified in Sudan where only 20% of
the total HCW generated was HW (Ahmed et
al., 2014).

On the other hand, between 75% and 90%of
the waste produced by health-care providers

are actually NHWs or GWs, and the
remaining 10‒25% is HWs in nature (WHO,
2014). It is apparent that the proportions
accounted by HWs from the present study
were higher than the same reported by the
WHO (2014). Yazie et al. (2019) pointed out
that the fractions of HW generated from
healthcare facilities were intolerably high with
a range stretching from 21‒70% of the total
solid waste. As indicated by Hayleeyesus and
Cherinete (2016), the higher proportion of
HWs in the present study (as well as in most
healthcare facilities in Ethiopia) could be
ascribed to the lack of segregation of waste at
the point of generation. In a study done on
private and government hospitals, Debere et
al. (2013) found that the HW and non-HWs
were mixed in the hospital’s temporary
storage areas.

Table 3. Distribution and healthcare solid waste generation rates by point source and type in
Private Hospital of Shashemene

Private
Hospital

Non-
Hazardous
Waste
(Kg
week–1)

Hazardous Waste
(Kg week–1)

Total
Hospital
Waste
(Kg Week–1)

Percentage
of Total
Hospital
Waste (%)

Average
Daily
Hospital
Waste (Kg
Day–1)

IW PhW SW * PaW

OPD 11.5 0.5 4.1 1.5 3.0 20.6 14 2.9

Surgical 12.1 2.3 2.5 2.5 2.2 21.6 15 3.1

Pediatrics 13.3 3.1 2.4 0.8 3.2 22.8 17 3.3

Obstetrics/Gyn. 11.9 2.0 0.7 1.6 4.1 20.3 15 2.9

Medical 8.2 1.9 4.2 2.2 1.5 18 13 2.6

Laboratory 9.4 4.3 - 2.0 - 15.7 11 2.2

Emergency 13.6 1.2 4.6 0.4 1.2 21 15 3.0

Total (Kg week–1) 80 15.3 18.5 11 15.2 140 100

20 ± 2.4
Mean ±  SD (Kg
day–1)

11.4 ± 2.0
2.2 ±
1.2

2.6 ±
1.8

1.6 ±
0.8

2.2 ±
1.4

20 ± 2.4 -

% wt. by Type 57.1 10.9 13.2 7.9 10.9 100 -

IW = Infectious Waste; PhW: Pharmaceutical Waste; SW: Sharp Waste; PaW: Pathological Waste
*Includes Needles, Blades, Lancet Needles, Syringes, and Scalpel Blades.



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

26

The types of hazardous wastes generated from
the study hospitals were infectious,
pharmaceutical, pathological, and sharps. In
both hospitals, the infectious [GH: 14.8%; PH:
10.9%] and pharmaceutical [GH: 13.2%; PH:
13.2%] wastes dominate the HWs category
while sharp wastes [GH: 6.2%; PH: 7.9%]
contribute for the lowest fractions to the total

as well as to the selfsame category in either
hospital (Tables 2 and 3). In a similar vein,
Hayleeyesus and Cherinete (2016) found that
infectious waste (21.1% of the total HCW)
dominated the HW fraction while the sharp
waste contributed the least (1.5%) to the total
solid waste from the healthcare facilities.

Table 4. Average daily healthcare solid waste generation by types of wastes in Shashemene
hospitals

Types of Waste
Type of Hospital

Government Private
Kg Day–1 Kg Bed–1 Day–1 Kg Day–1 Kg Bed–1 Day–1

General Waste 24.1 0.1 11.4 0.11
Infectious Waste 6.7 0.03 2.2 0.02
Pharmaceuticals 5.9 0.025 2.6 0.024
Sharps 2.8 0.012 1.6 0.015
Pathological Wastes 5.7 0.024 2.2 0.02
Total HCSW 45.2 0.20 20 0.19
HCSW stands for Healthcare Solid Waste

In the GH (Table 2) the highest percentage of
the total HCW was generated from OPD (18%)
followed by Obstetrics/Gynecology (16%)
while the lowest proportion of total waste was
generated from Surgical Ward (12%). On the
other hand, the Pediatric Ward (17%) followed
by Obstetrics/Gynecology, Emergency, and
Surgical wards (15% each) contributed for the

highest fractions of total waste generated from
PH whereas the waste proceeding from the
Laboratory (11%) was the lowest proportion of
the total HCW (Table 3). Meleko and Adane
(2018) reported that the largest portions of total
waste were contributed by Gynecological Ward
followed by Medical Ward while the lowest
proportion was generated in Office.

As to the data presented in Table 5, there were
significant differences in the different wards of
the Government Hospital with respect to
general waste (χ2 = 31; P <0.001), hazardous
waste (χ2 = 25; P <0.001), and total healthcare
waste (χ2 = 46; P <0.01). Likewise, significant
variations were observed in the Private
Hospital wards regarding the general waste

(χ2= 13; P <0.01), hazardous waste (χ2 = 10; P
<0.01), and total healthcare waste (χ2 = 22; P
<0.01). Similarly, Meleko and Adane (2018)
reported that there were significant variations
among the different wards in relation to general
waste (χ2=41.815;P< 0.01), hazardous waste
(χ2=44.324;P<0.01), and total healthcare waste
(χ2 = 44.604;P< 0.01).



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

27

Table 5. Comparison of mean generation rate of healthcare solid waste and categories of
HCSW by departments within the government and private hospitals using Kruskal Wallis
H test

Wards
Type of Hospital

Government Private
GW HW THCW GW HW THCW

OPD 30.3 27.5 57.8 11.5 9.1 20.6
Surgical 27.9 10.1 38 12.1 9.5 21.6
Pediatrics 20.4 23.6 44 13.3 9.5 22.8
Obs/Gyn. 16.5 33.4 49.9 11.9 8.4 20.3
Medical 27.6 17.6 45.2 8.2 9.8 18
Laboratory 15.9 26.2 42.1 9.4 6.3 15.7
Emergency 30 9.5 39.5 13.6 7.4 21
Chi-Square 31 25 46 13 10 22
P-Value 0.0001 0.0001 0.001 0.001 0.001 0.001
GW: General waste; HCW: Healthcare Waste; HW: Hazardous Waste; Obs/Gyn:
Obstetrics/Gynecology; OPD: Outpatient Department

According to Table 6, there were significant
differences between the mean total HCW (χ2 =
9.016;P< 0.01), general waste (χ2 = 9.8;P<
0.01) and the hazardous waste (χ2 = 5.011;P<
0.05) of the study hospitals. Similar to the

findings of the present study, Debere et al.
(2013) reported that there was statistically
significant difference for total amount of HCW
(χ2 = 30.65;P< 0.001),HW (χ2 = 20.431;P <
0.01) and NHW (χ2 = 29.011;P< 0.001) among
the surveyed hospitals.

Table 6. Comparison of healthcare waste generation rates and categories of HCW using
Kruskal-Wallis test among the surveyed hospitals

Type of Hospital
Mean Rank

Total HCW* GW** HW***
Government 10.86 11.00 10.00

Private 4.14 4.00 5.00

Chi-square 9.016 9.800 5.011

P- Value 0.003 0.002 0.025

* Healthcare Waste, ** General Waste, *** Hazardous Waste

The Spearman’s rank correlation coefficient
(rs) (Table 7) showed that there was a positive
linear relationship between number of patients
and quantities of hazardous waste generation
rates in both PH (r = 0.954, P< 0.05) and GH
(r = 0.847, P< 0.01). Similarly, there was
positive correlation coefficients among HW
generation rates and occupied beds in both PH

(r = 0.964, P< 0.05) and GH (r = 0.821, P<
0.001) (Table 7). Moreover, positive
associations were observed between patient
flow and occupied beds in PH (r = 0.991, P<
0.01) and GH (r = 0.955, P< 0.05). In their
study on HCWs, Tadesse and Kumie (2014)
found that there was a positive linear
relationship between number of patients and



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28

the HCWs generated in all government
facilities studied. Conversely, Issam et al.
(2009), Haylamicheal et al. (2011), and

Komilis et al. (2011) reported that there was a
positive correlation between the total HCW
generation rates and the number of beds.

Table 7. Spearman’s Correlation Matrix (rs) between Hazardous Wastes (HW) generated,
Patient Flow and Occupied Beds in Private and Government Hospitals
Government Hospital HW Patient Flow Occupied Beds
Spearman’s rho HW 1.00 0.954⁎⁎ 0.964⁎⁎⁎

Patient Flow 1.00 0.955⁎⁎
Occupied Beds 1.00

Private Hospital HW Patient Flow Occupied Beds
Spearman’s rho HW 1.00 0.847⁎ 0.821⁎

Patient Flow 1.00 0.991⁎⁎
Occupied Beds 1.00

⁎, ⁎⁎, and ⁎⁎⁎ represent P < 0.05, P < 0.01, and P < 0.001, in that order

CONCLUSION

Although the HCW generations rates were
relatively low, the standard HCW segregation
was lacking in both hospitals. Consequently,
except the sharp materials, all other HCWs
were mixed with the GWs (mainly in GH),
and hence, the proportion of HWs generated
in the study hospitals surpassed the
corresponding threshold measure indicated by
the WHO. Besides, the waste collectors
handle the HCWs without employing PPE,
exposing themselves to potential health risk.
Both hospitals principally treated HCW using
low combustion single-chamber incinerators
which could potentially contribute to the
release of huge amounts of air pollutants to
the environment.

As the HCW management in both hospitals
was poor, sufficient resource allocation,
periodic training, and strict supervision and
proper implementation of HCW management

is pivotal. Additionally, heath care facilities in
Oromia region, should acquaint HCW
management guideline for standardized waste
categorization and safer handling. Besides, the
key stakeholders of the region involving heath
care directors, experts and policy developers
should join hands in structuring the HCW
management system in a way that appraises
human and environmental health. For this,
further researches need to be conducted in
health care facilities of the region and the
wider nation with consideration of human
health risk assessment.

Ethical Consideration

Ethical clearance was obtained from Zonal
Health Office whereas an approval to conduct
the study was secured from the
Managers/Directors of the respective
Hospitals. The experimental procedures were
explained to the individual participants and
thereafter their consent to participate in the
study was obtained. The participants were free
either to participate or not. Besides, the right



East Afr. J. Biophys. Comput. Sci. (2023), Vol. 4, No. 2, 13-30

29

of respondents to interrupt or withdraw the
interview when they deem it necessary was
duly respected. Data collectors were trained
touse protective materials when handling
healthcare wastes. Privacy and confidentiality
were assured by way of employing anonymity.

Conflicts of Interest

The authors declare that there are no conflicts
of interest regarding the publication of this
paper.

Acknowledgements

Many individuals and institutions have helped
us while conducting the present study. We are
highly appreciative of the cooperation of the
study hospitals (the administration, healthcare
workers and waste handlers). We are deeply
indebted to Adanech Bekele Guta for her
support and suggestions to execute the
research work. We are grateful to Ato Melesa
Bekele Tola for his assistance with equipment
calibration, invaluable comments and
information relevant to execute this work.

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.


	Introduction
	Mathematical Model
	Crisp equivalent of multi-objective fuzzy transportation problem
	Solution procedure
	Numerical example
	Discussion of the results

	Conclusion
	Basic Preliminaries

