Sharps waste is part of infectious waste generated in health facilities, management of which is critical. This study aimed at assessing the sharps waste management practices in a referral hospital. The study was conducted at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Data on sharps waste containers (SWCs) management in generation rates was collected for 60 days, while waste incineration data was collected from 65 randomly selected days. This study gives a picture on how

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... wastes are managed from generation to final disposal. The average weight per used safety box observed in this study (1.54 kg/box) was far above the average weight of a normally filled safety box (0.79 kg/box) indicating that most of the safety boxes are overfilled at MNH. The overfilling of SWCs at MNH was at an average of 10.7% of all the SWCs collected, with a maximum value of 30%, indicating a problem in sharps waste management within the hospital. The sharps waste generation rate observed in a referral hospital (40.8 kg/day) was higher than values reported in district hospitals, but the sharps waste proportion in the infectious medical waste incinerated at MNH was low (at 4% on average). Increasing sharps waste proportion in the waste load increased the incinerator performance in terms of fuel effectiveness. The amount of ash collected from the incinerator per day was observed to be minimal compared to literature data. The final ashes were 5.4% of the total waste loaded, which indicates that the incinerator is more effective in weight reduction, rated at 94.6% efficient.