A recent study across 12 government and private hospitals in Dhaka revealed stark contrasts in toilet functionality and cleanliness.
Conducted by icddr,b scientists, the University of Technology Sydney, and the Directorate General of Health Services (DGHS) Bangladesh, the study was published in PLOS ONE, according to a press release.
The researchers assessed 2,459 toilets, finding 68% of government hospital toilets functional, with only 33% clean, while in private hospitals, 92% were functional, and 56% were clean. Dr. Md. Nuhu Amin, the study’s principal investigator, suggested the situation might be worse than reported due to the post-COVID-19 context, which likely reduced toilet usage.
The study highlighted the urgent need for increased resources to maintain clean and functional toilets, particularly addressing gender and disability needs. Poor toilet access and hygiene pose significant health risks, potentially spreading diseases like cholera and typhoid, especially in hospitals where pathogens are prevalent.
User-toilet ratios in outpatient facilities were alarmingly high, with one toilet for every 214 users in government hospitals and 94 in private hospitals, falling far short of WaterAid's guidelines. These guidelines recommend one toilet per 20-25 patients or carers, up to the first 100, with an additional toilet for every 50 more.
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Both hospital types also failed to meet Bangladesh’s national WASH standard, which mandates one toilet per six inpatient beds. Government hospitals had 17 users per toilet, while private hospitals had 19. Furthermore, less than 1% of toilets were equipped for disabled persons, and only 3% had trash bins for menstrual pads and solid waste.
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Toilet functionality was assessed using World Health Organization (WHO) and UNICEF criteria, while cleanliness was judged based on the presence of visible faeces, strong faecal odour, flies, sputum, insects, rodents, and solid waste.
Globally, few studies have characterized toilet conditions and user-to-toilet ratios in large urban hospitals in low- and middle-income countries (LMICs). This research fills a critical gap, providing data essential for policy changes aimed at improving sanitation in Dhaka’s healthcare facilities. Ensuring basic sanitation is vital for achieving the United Nations Sustainable Development Goals (SDGs) by 2030.
The findings underscore the need for immediate action to address inadequate sanitation in hospitals, crucial for protecting public health and preventing disease transmission.