Disposable diaper consumption in sub-Saharan Africa: Estimating the risks of associated unsafe waste

Disposable diaper use is widespread in many low- and middle-income countries whilst waste collection services are scarce. Despite the potential environmental and public health impacts of disposable diaper consumption by households lacking waste services, an international system for monitoring such consumption is lacking. This study therefore aims to develop and evaluate a method for estimating disposable diaper use based on secondary data, specifically nationally representative household expenditure surveys. Disposable diaper expenditure reported via household expenditure surveys for Nigeria (from 2018–19), Kenya (2015–16) and Ghana (2016–17) was used to estimate national disposable diaper consumption among households lacking waste collection services. To assess plausibility of reported expenditure, consumption-smoothing was examined, and Receiver Operating Curve analysis was used to infer mean toilet-training age. In Ghana, Kenya and Nigeria, households lacking appropriately managed waste services consumed an estimated 19 million, 210 million and 285 million disposable diapers per year (292 child/year, 433 child/year and 59 child/year among nappy-consuming households), respectively. Mean toilet-training ages were 24 to 30 months. Disposable diaper purchasing patterns showed evidence of consumption-smoothing among poorer households. Where commodity coding allows, household expenditure surveys can be used to construct internationally comparable indicators depicting disposable diaper consumption among households lacking waste services. Such indicators could be used to advocate for accelerated diaper product innovation, and target areas with high disposable diaper consumption but low waste service coverage.Author summary: Rapidly changing urban lifestyles in low and middle-income countries are leading to greater consumption of many products that generate plastic waste including disposable diapers. Whilst convenient, disposable diaper consumption pose waste management challenges in cities where coverage of waste collection services is incomplete, risking their entry into the environment. In our study, inspired by our own field observations of discarded diapers, we used household expenditure surveys to estimate consumption of disposable diapers among households lacking waste services in Ghana, Kenya, and Nigeria. We find households without waste services consumed an estimated 19 million, 210 million and 285 million disposable diapers annually, reflecting higher waste collection coverage in Ghana. However, in Nigeria, since the survey asks respondents to recall diaper consumption over a longer period compared to Ghana and Kenya, it likely under-estimates diaper consumption. Since household expenditure survey data are available for many years and in many countries, these surveys could be used more widely for international monitoring of mismanaged disposable diaper waste and potentially also mismanaged waste from consumption of other products.