Staff Correspondent

Patients and their attendants are at risk of getting infected with new diseases at hospitals as an icddr,b study has found poor toilet access and hygiene conditions in healthcare facilities of Dhaka city.

The study has found that 68% of government hospital toilets were functional with only 33% being clean while in private hospitals, 92% were functional with 56% being clean.

The findings of the study conducted by the icddr,b scientists in collaboration with partners at the University of Technology Sydney, Australia and the Directorate General of Health Services (DGHS) were recently published in international health journal PLOS ONE.

According to the study, poor toilet access and hygiene pose significant health risks, potentially spreading diseases like cholera and typhoid while proper sanitation and its accessibility are particularly crucial in hospitals where disease-causing pathogens are expected to commonly circulate.

The study evaluated 2,459 toilets in Dhaka’s healthcare facilities to assess the availability, functionality and cleanliness of toilets.

High user-to-toilet ratios were observed in outpatient facilities with one toilet for every 214 users in government hospitals and 94 users in private hospitals, significantly below the recommended standards set by WaterAid, it added.

According to the WaterAid guidelines for the construction of institutional toilets in outpatient facilities, there should be one toilet for every 20-25 patients or carers, up to the first 100 individuals, with an additional toilet for every additional 50 patients or carers.

Additionally, both government and private hospitals failed to meet the criterion of one toilet per six inpatient beds by the Bangladesh national WASH standard and implementation guidelines from 2021.

There were 17 users for each toilet in government hospitals and 19 in private hospitals.

Beyond basic functionality, hygiene and availability, less than 1% of toilets had facilities for people with disability and only 3% of toilets had a trash bin for the disposal of menstrual pads and solid waste.

The researchers defined toilet functionality according to criteria used by the World Health Organization (WHO) and UNICEF and assessed toilet cleanliness based on the presence of visible faeces on any surface, strong faecal odour, flies, sputum, insects, rodents, and solid waste.

“The actual sanitation conditions in Dhaka hospitals may be worse than what we found as our study was conducted in the aftermath of the COVID-19 pandemic when many hospitals were shifting from mainly treating COVID-19 patients to general medical care.

This could have led to reduced patient flow and toilet usage,” said icddr,b’s associate scientist and principal investigator of the study Dr Md Nuhu Amin.

He further said the increase in resources allocated for maintaining clean and working toilets in hospitals is needed, with a particular focus on meeting gendered needs and those of persons with disability.

Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in low- and middle-income countries (LMICs).

Ensuring basic sanitation for all is a priority for countries to achieve the United Nations Sustainable Development Goals (SDGs) by 2030.

The study addresses the research gap in LMICs and provides important data to drive policy changes at the national level to tackle the critical health problem of inadequate sanitation in healthcare facilities in Dhaka.