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;

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Lily Horng Stanford University, Stanford, California;

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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;

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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;

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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;

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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;

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Md. Khairul Islam Water Aid Bangladesh, Dhaka, Bangladesh

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Aftab Opel Water Aid Bangladesh, Dhaka, Bangladesh

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Stephen P. Luby Stanford University, Stanford, California;

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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.

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