Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey

Leanne Unicomb Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

Search for other papers by Leanne Unicomb in
Current site
Google Scholar
PubMed
Close
,
Lily Horng Stanford University, Stanford, California;

Search for other papers by Lily Horng in
Current site
Google Scholar
PubMed
Close
,
Mahbub-Ul Alam Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

Search for other papers by Mahbub-Ul Alam in
Current site
Google Scholar
PubMed
Close
,
Amal K. Halder Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

Search for other papers by Amal K. Halder in
Current site
Google Scholar
PubMed
Close
,
Abul K. Shoab Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

Search for other papers by Abul K. Shoab in
Current site
Google Scholar
PubMed
Close
,
Probir K. Ghosh Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

Search for other papers by Probir K. Ghosh in
Current site
Google Scholar
PubMed
Close
,
Md. Khairul Islam Water Aid Bangladesh, Dhaka, Bangladesh

Search for other papers by Md. Khairul Islam in
Current site
Google Scholar
PubMed
Close
,
Aftab Opel Water Aid Bangladesh, Dhaka, Bangladesh

Search for other papers by Aftab Opel in
Current site
Google Scholar
PubMed
Close
, and
Stephen P. Luby Stanford University, Stanford, California;

Search for other papers by Stephen P. Luby in
Current site
Google Scholar
PubMed
Close
Restricted access

We conducted a nationally representative cross-sectional study of 875 health-care facilities (HCFs) to determine water, sanitation, and health-care waste disposal service levels in Bangladesh for doctors, staff, and patients/caregivers in 2013. We calculated proportions and prevalence ratios to compare urban versus rural and government versus other HCFs. We report World Health Organization (WHO)-defined basic HCF service levels. The most common HCF was nongovernmental private (80%, 698/875), with an average of 25 beds and 12 admissions per day. There was an improved water source inside the HCF for doctors (79%, 95% confidence intervals [CI]: 75, 82), staff (59%, 95% CI: 55, 64), and patients/caregivers (59%, 95% CI: 55, 63). Improved toilets for doctors (81%, 95% CI: 78, 85) and other staff (73%, 95% CI: 70, 77) were more common than for patients/caregivers (54%, 95% CI: 50, 58). Forty-three percentage (434/875) of HCFs had no disposal method for health-care waste. More urban than rural and more government than other HCFs had an improved water source on the premises and improved toilets for staff. WHO-defined basic service levels were detected in > 90% of HCFs for drinking water, among 46–77% for sanitation, and 68% for handwashing at point of care but 26% near toilets. Forty-seven percentage of HCFs attained basic health-care waste management service levels. Patient/caregiver access to water, sanitation, and hygiene facilities is inadequate in many HCFs across Bangladesh. Improving facilities for this group should be an integral part of accreditation.

Author Notes

Address correspondence to Leanne Unicomb, Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh. E-mail: leanne@icddrb.org

Financial support: This study was funded by WaterAid Bangladesh.

Authors’ addresses: Leanne Unicomb, Mahbub-Ul Alam, Amal K. Halder, Abul K. Shoab, and Probir K. Ghosh, Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh, E-mails: leanne@icddrb.org, mahbubalam@icddrb.org, amalkrishna.halder@gmail.com, akmshoab@icddrb.org, and probir@icddrb.org. Lily Horng, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, E-mail: lhorng@stanford.edu. Md. Khairul Islam and Aftab Opel, WaterAid Bangladesh, Dhaka, Bangladesh, E-mails: khairulislam@wateraid.org and aftabopel@wateraid.org. Stephen P Luby, Stanford Woods Institute for the Environment, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu.

  • 1.

    Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P, 2008. Global trends in emerging infectious diseases. Nature 451: 990993.

  • 2.

    Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D, 2011. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 377: 228241.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    NIPORT, 2016. Bangladesh Health Facility Survey 2014. Dhaka, Bangladesh: National Institute of Population Research and Training (NIPORT), Associates for Community and Population Research (ACPR), and ICF International. Available at: https://dhsprogram.com/pubs/pdf/SPA23/SPA23.pdf. Accessed July 4, 2018.

    • PubMed
    • Export Citation
  • 4.

    Bhuiyan MU et al. 2014. Incidence of and risk factors for hospital-acquired diarrhea in three tertiary care public hospitals in Bangladesh. Am J Trop Med Hyg 91: 165172.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Islam MS, Luby SP, Sultana R, Rimi NA, Zaman RU, Uddin M, Nahar N, Rahman M, Hossain MJ, Gurley ES, 2014. Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control. Am J Infect Control 42: 305310.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Rimi NA, Sultana R, Luby SP, Islam MS, Uddin M, Hossain MJ, Zaman RU, Nahar N, Gurley ES, 2014. Infrastructure and contamination of the physical environment in three Bangladeshi hospitals: putting infection control into context. PLoS One 9: e89085.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    WHO, 2016. Monitoring WASH in Health Care Facilities. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Export Citation
  • 8.

    Horng LM, Unicomb L, Alam MU, Halder AK, Shoab AK, Ghosh PK, Opel A, Islam MK, Luby SP, 2016. Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey. J Hosp Infect 94: 286294.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Alam MU, Luby SP, Halder AK, Islam K, Opel A, Shoab AK, Ghosh PK, Rahman M, Mahon T, Unicomb L, 2017. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey. BMJ Open 7: e015508.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    WHO/UNICEF, 2015. WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Export Citation
  • 11.

    National Institute of Population Research and Training (NIPORT), Associates for Community and Population Research (ACPR), and ICF International, 2016. Bangladesh Health Facility Survey 2014. Dhaka, Bangladesh: NIPORT, ACPR, and ICF International.

    • PubMed
    • Export Citation
  • 12.

    WHO/UNICEF, 2017. WASH in the 2030 Agenda: New Global Indicators for Drinking Water, Sanitation and Hygiene. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Export Citation
  • 13.

    Islam MA, Islam M, Hasan R, Hossain MI, Nabi A, Rahman M, Goessens WHF, Endtz HP, Boehm AB, Faruque SM, 2017. Environmental spread of New Delhi metallo-β-lactamase-1-producing multidrug-resistant bacteria in Dhaka, Bangladesh. Appl Environ Microbiol 83: pii: e00793–17.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hadley MB, Roques A, 2007. Nursing in Bangladesh: rhetoric and reality. Soc Sci Med 64: 11531165.

  • 15.

    Bhalla A, Suri V, Kaur P, Kaur S, 2014. Involvement of the family members in caring of patients an acute care setting. J Postgrad Med 60: 382385.

  • 16.

    Hoffman M, Mofolo I, Salima C, Hoffman I, Zadrozny S, Martinson F, Van Der Horst C, 2012. Utilization of family members to provide hospital care in Malawi: the role of Hospital Guardians. Malawi Med J 24: 7478.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    WHO/UNICEF, 2015. Water, Sanitation and Hygiene in Health Care Facilities: Status in Low and Middle Income Countries and Way Forward. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Export Citation
  • 18.

    Hassan MM, Ahmed SA, Rahman KA, Biswas TK, 2008. Pattern of medical waste management: existing scenario in Dhaka city, Bangladesh. BMC Public Health 8: 36.

  • 19.

    Patwary MA, O’Hare WT, Sarker MH, 2011. An illicit economy: scavenging and recycling of medical waste. J Environ Manage 92: 29002906.

  • 20.

    Sarker MA, Harun-Or-Rashid M, Hirosawa T, Abdul Hai MS, Siddique MR, Sakamoto J, Hamajima N, 2014. Evaluation of knowledge, practices, and possible barriers among healthcare providers regarding medical waste management in Dhaka, Bangladesh. Med Sci Monit 20: 25902597.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    WHO, 2008. Essential Environmental Health Standards in Health Care. Adams J, Bartram J, Chartier Y, eds. Geneva: Switzerland: World Health Organization.

    • PubMed
    • Export Citation
  • 22.

    Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D, 2012. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med 9: e1001244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Seman Y, 2016. Clean and Safe Health Facility Initiative (CASH) in Ethiopia. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 301 247 40
Full Text Views 678 10 1
PDF Downloads 355 7 4
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save