Bio-medical waste management performance: A cross-sectional study of health care establishments in Dhaka city, Bangladesh

Abstract

Effective bio-medical waste management (BMWM) is critical for urban public health; however, compliance across healthcare establishments (HCEs) are inconsistent and it remains a systematic challenge in Dhaka City Bangladesh. This study evaluated BMWM performance across diverse healthcare establishments (HCEs) using a weighted Bio-Medical Waste Management Performance Index (BMWMPI). A cross-sectional analysis of 177 HCEs was conducted across Dhaka North (DNCC), Dhaka South (DSCC), and peri-urban areas using an eight-pillar framework. Data were analyzed using Pearson correlation, One-way ANOVA with Tukey’s HSD, and Random Forest regression to identify primary performance predictors. The overall BMWMPI averaged 5.287 (SD=1.236), reflecting moderate compliance. Private facilities (M=5.40) significantly outperformed government hospitals (M=4.45, p<0.01), and DNCC institutions scored higher than DSCC and peri-urban counterparts (p<0.01). While top-performing private HCEs demonstrated robust infrastructure, large public medical colleges exhibited critical operational deficiencies. Random Forest analysis identified a “safety–security–characterization” triad—comprising site security, waste characterization, and animal access—as the primary driver of performance. Results reveal a pervasive “structural-operational decoupling,” where existing physical infrastructure is undermined by inadequate segregation and occupational safety protocols. Weak environmental containment and public exposure to waste elevate risks for healthcare workers and urban communities. Principal component analysis confirms that being a large facility does not generate superior protocols. Instead, multivariate modeling identifies PRISM Bangladesh involvement as the most powerful predictor of success, increasing livelihood of cleanliness standards by 13.9 times. Targeted regulatory enforcement and strengthened institutional accountability, particularly within public tertiary hospitals, are essential to enhance urban environmental governance and mitigate health risks. These findings highlight an urgent need for secured disposal zones, specialized waste staff, and public-private partnerships to bridge the compliance gap in high-volume facilities.

Bangladesh J. Zool. 54(1): 75-96, 2026