See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/254096670

Medical Waste Management (MWM) in Dhaka, Bangladesh

Article  in  Home Health Care Management & Practice · May 2012

DOI: 10.1177/1084822311425235

CITATIONS READS
11 9,186

3 authors:

Syed Emdadul Mahmuda Mutahara

University of Chicago 9 PUBLICATIONS   168 CITATIONS   
36 PUBLICATIONS   550 CITATIONS   
SEE PROFILE
SEE PROFILE

Mosiur Rahman
University of Rajshahi
106 PUBLICATIONS   1,057 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Article Pullout Resistance of Concrete Anchor Block Embedded in Cohesionless Soil View project

Measuring Quality of Life View project

All content following this page was uploaded by Syed Emdadul on 03 May 2015.

The user has requested enhancement of the downloaded file.

Original Article
Home Health Care Management & Practice

Medical Waste Management (MWM) 24(3) 140­–145

© 2012 SAGE Publications
Reprints and permission:
in Dhaka, Bangladesh:  It’s a Review sagepub.com/journalsPermissions.nav
DOI: 10.1177/1084822311425235
http://hhc.sagepub.com

Emdadul H. Syed, MSc, MHSc1, Mahmuda Mutahara, MSc2,

and Mosiur Rahman, MSc, MHSc3

Abstract
This study reviews the current situation of medical waste management (MWM) and practices in Dhaka, Bangladesh, and
examines possible solutions for further study. We collected existing information through an Internet survey using the
keywords “Medical Waste Management,” “Health Hazards,” and “Bangladesh.” Medical wastes that are disposed in open places
in the city are hazardous and toxics. Moreover, waste management and practices were found to be quite unsafe. Poor people
collect the waste and sell it for recycling. Almost 85.0% of sharp injuries are caused between their usage and subsequent
disposal. More than 20.0% of those who handle them encounter “stick” injuries. Another study showed that people use an
average of 3.4 injections per year, in which 39.3% were administered with reused equipment for low level of management.
There is no initiative for present MWM system by government or INGOs, and no concrete regulation has been established
yet. Few researchers and INGOs have done little. Women and children are more vulnerable because they handle the waste
with bare hands; exposing them to contamination with HIV or hepatitis B and other diseases. Therefore, it is essential to
follow sound medical waste management system and take actions for this public health problem.

Keywords
medical waste, management, practices, health hazards, Bangladesh

Introduction devices, and radioactive materials. 12 The WHO also

Globally, Medical Waste Management (MWM) is a one of
the crucial public health concerns with a huge environmental
threat.1,2 Over the last decade, the growth of the medical sec-
tor around the world combined with an increase in the use of
disposable medical products has contributed to the large
amount of medical waste being generated.3-5 Medical waste
including home care materials contains highly toxic metals,
toxic chemicals, pathogenic viruses, and bacteria.6,7 As a
result, several studies showed that this medical waste can
present a mechanism for transmission of severe health prob-
lems as it contains highly toxic chemicals.5,7-10 Previously,
one report showed that, 5.2 million people (including
4 million children) die from waste-related diseases in each
year (United Nations Conference on Environment and
Development [UNCED] in Rio de Janerio in June 1992).
The definition of Medical Waste by Basel Action
Network (BAN) & Health Care Without Harm (HCWH) is
“any solid or liquid waste that is generated in the diagnosis,
treatment or immunization of human beings or animals
in research pertaining there to, or in the production or test-
ing of biologically.”11 As per World Health Organization,
waste generated by health care activities includes a broad
range of materials, such as used needles, syringes, diagnos-
tic samples, blood, chemicals, pharmaceuticals, medical
reported that poor management of health care waste may
cause infection, toxic effects, injuries, and risks for pollut-
ing the environment as well as affecting health care work-
ers, waste handlers, patients, family members, and even the
community people at large scale. An estimate by WHO
showed that injections with contaminated syringes caused
21 million hepatitis B infections, 2 million hepatitis C virus
infections, and 260,000 HIV infections per year.13 The
other study reported medical wastes bring higher risk to
health than general waste.14 It is essential that all medical
waste materials are segregated at the point of generation,
appropriately treated, and disposed of safely. Health care
activities lead to the production of medical wastes that may
induce adverse health effects.15,16 The study conducted in
1
The University of Tokyo, Bunkyo-ku, Japan
2
Center for Environmental and Geographic Information Services, Dhaka,
Bangladesh
3
University of Rajshahi, Bangladesh.
Corresponding Author:
Emdadul H. Syed, Department of Community and Global Health, Graduate
School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku,
Tokyo 113-0033, Japan
Email: emdad91@gmail.com
Syed et al. 141
India showed that the percentage of medical wastes in the
total waste stream was comparatively high, ranging from
12.5% to 69.3%, which indicated poor waste handling
practice.16
In Bangladesh, the medical waste generation rate is esti-
mated to be 0.8 to 1.67 kg/bed/day, so that annual medical
waste generation rate will be 93,075 tons per year.17 About
one fifth of this waste would be classified as highly hazardous
waste by World Health Organization’s (WHO) guidelines.18
As per the situation in Dhaka, the capital city in Bangladesh,
about 840 clinics, hospitals, and diagnostic centers produce
medical waste.18 However, until recently, there has been an
improper procedure of medical waste management in Dhaka
City.19 Besides, Bangladesh does not have any particular
chemical policy.20 Due to lack of national chemical policy
and law, management for medical wastes in Bangladesh is
fragmented.21 There have been few studies and very little
attention that highlighted importance of the medical waste
management in Bangladesh. Therefore, the objectives of this
study were (a) to describe the current situation of medical
waste management at Dhaka city in Bangladesh, (b) to
describe health effects of existing MWM practices, and (c) to
examine possible solutions regarding this important public
health issue compared with other countries.
Method
We carried out a literature survey using databases of
“PubMed,” “Medline,” and “POPLINE” for articles on
medical waste in Bangladesh. In addition, we conducted
and searched for related articles that could be downloaded.
The present study was conducted from June 2009 to
January, 2010. Information was obtained through the
Internet by using MeSH keywords “Medical waste,”
“Bangladesh,” “Health Hazards,” and “Knowledge and
Management” from the year 1992 to 2010.
Besides that, we searched for related articles on medi-
cal waste management from Dhaka City Corporation
(DCC), Bangladesh Rural Advancement Committee
(BRAC), Bangladesh Center for Advanced Studies
(BCAS), Bangladesh Environmental Lawyers Association
(BELA), Asian Development Bank (ADB), and World
Health Organization (WHO). We also obtained information
from the government officials report book.22 In total, we
searched 36 articles for this review.
Results
Medical Waste Quantities
During 1996, total garbage generation was 350 metric tons
per day in Dhaka city, in which only 5.7% (19.9 metric tons)
are from medical institutes.23 After 10 years, around 37±5
metric tons per day of medical wastes are generated in
Medical waste
City Corporation dustbin with
Open places
solid waste
Waste pickers (Tokai)
City cleaner taking all together
collected forselling
without using any gloves
Recycling for Burning at
selling open places Putting in open places
Burning at open area
Figure 1. common steps of medical waste collection in Bangladesh
Dhaka City, due to increase in health centers. From this
amount, about 21.0% are infectious and hazardous.18 Most
toxic hazards come from clinics and hospitals, whereas few
come from domestic and industrial sources. The contribu-
tion of infectious hazards, sharps, and pathological waste is
10.5%, 3.5%, and 1.5% respectively.24
Waste Collection and Disposal
It is an alarming situation that waste generated inside the
hospitals were collected without any separation by untrained,
unprotected, and unaware cleaners.25 Waste collection was
carried out using open bucket (44.4%) and plastic bowl
(23.9%).21 Medical wastes were disposed of in several
places: the City Corporation’s dustbin, a pit near the hospital
(dig a hole), an open field/road side, or at the canal water/
river.21 Most waste was disposed in municipal bins (59.0%)
without any separation.21 A common step of disposal of
medical waste in Bangladesh is as shown in Figure 1:
After an operation, they put waste in plastic boxes (some-
times in open boxes). Then the cleaners put the medical
waste in a hole or city corporation dustbin with solid waste.
A few times they separated it. Waste pickers collected and
sold the waste for recycling. City cleaners took the rest of the
waste at the city corporation burning area.
Medical Waste and “Tokai” in Bangladesh
Many hospitals sold the empty saline bags, bottles, syringes,
and other materials for recycling purposes.25 Urban poor
called Tokai in Bangladesh rely on the collection of second-
ary materials for their primary source of income (Figure 2
& 3).26 The wastes pickers (Tokai) sort through waste at the
site, which are usually open dumps, and sell anything that
can be recycled to agents of industry (Figure 5 & 6).26 The
amount collected depended on the area and season. They
usually sold per kg 20Tk, which is about $2 USD per day
(Figure 4).27
142 Home Health Care Management & Practice 24(3)

Figures 2 and 3.36 Injectable drug user collected for sale

Figure 4.36 Buying places for Tokai Figure 5.38 Store in open places

Medical Waste and Environmental Hazards

Hospital wastes that are disposed in common dustbins in the
city are hazardous and toxic. The laboratory analyses of
wastes during September 1998, July 2000, and March 2001
by the International Center for Diarrhoeal Disease Research,
Bangladesh’s (ICDDR, B) showed the presence of infectious
wastes and risk of severe contamination of the environment.24
Runoff from untreated infectious wastes or human excrement
dumped on the land may contaminate surface and ground
water exposing the population to the risk of diseases and
parasites. Uncontrolled burning of medical waste pollutes the
air with acid gases, dioxins, furans, and heavy metals.28

Medical Waste and Health Hazards

Figure 6.38. Burning at open places
Medical devices are produced with the addition of polyvi-
nyl chloride plastics (PVC) and di-2-ethylhexyl phthalate
Syed et al. 143
(DEHP). Laboratory analysis show that addition of PVC
and DEHP are greatest health risk.29 However, a survey
determining prevalence of diseases within 15 days of
disposal indicated that 41.0% of nurses suffered from
diseases contracted in a short time (15 days). About
60.0% cleansers and 57.0% waste collectors/local residents
also suffered.24
Exposure to these chemicals has been linked to cancer,
as well as reproductive, cardiac, hepatic, and develop-
mental disorders.29 It is evident from the World Bank
report that HBV, HCV, and even HIV can spread through
hospital waste. The reuse of unsterilized syringes results
in 8 to 16 million hepatitis B, 2.3 to 4.7million hepatitis
C, and 80,000 to 160,000 HIV infectious annually.30 These
chronic infections lead to a high burden of morbidity and
mortality.30,31 Another study also showed that in develop-
ing countries people use an average of 3.4 injections per
year, in which 39.3% were administered with reused
equipment.32
Waste Management Knowledge and Practice
Most hospitals and diagnostic centers do not know how to
handle and dispose medical waste. 38.1% of the concerned
staffs have not received any training to handle medical
waste.33 One study shows that among doctors, about 8.0%
practiced properly, 32.0 % improperly, and 60.0% were
uncertain of disposal practices. Among nurses it was about
5.0% the proper way, 35.0% the improper way, and 60.0%
uncertain.24
Medical Waste to Home Care
About the medical waste management in home, the situa-
tion is worse because people at home are not aware of
health effects of medical waste. Similarly, the present situ-
ation makes for potential harm to pharmacists.34 In
Bangladesh, most of the caregivers are of older age. They
mix the medical waste with home waste, which is very
serious to get infections.
Discussion
The waste pickers have no special protection for sorting
through wastes and are in danger of becoming seriously
injured or sick. They suffer from various kinds of infectious
diseases such as viral hepatitis B/C, typhoid, skin disease/
allergy, diarrhea, tuberculosis, and malaria.26,35 As per BAN
& HCWH, sharps, which include syringes and needles, have
the highest disease transmission potential amongst all cate-
gories of medical waste. More than 20.0% of those who
handle them encounter “stick” injuries. It is reported that
there were several accidents (10 cases out of 17) of injury
due to exposure to medical wastes inside or outside of
hospital premises. These were as follows:
• Hands cut due to handling broken glass;
• Permanently damaged/curved fingers due to needle
injuries;
• Legs and hands became paralyzed from an injury
by a needle.
Hospital wastes, including the waste collected from home care,
poses a significant threat to human health and environment. In
Bangladesh, many people get treatment at home from the local
doctor. The medications that are not provided by professionals
increase the risk of exposure of the caregivers and family
members. Caregivers and family members throw away the
used needles, syringes, and other items in open places. Then
children use the used items as their playing and fun instru-
ments. Proper waste management strategy is needed to ensure
health and environment safety. Efficient health care waste
management is crucial for protecting health care workers,
patients, and the community against exposure toward infec-
tions, toxic wastes, and injuries as well as the protection of the
environment (Safe Management of Wastes From Health Care
Activities; World Health Organization, Geneva).
Thus it is imperative to dispose these medical wastes and
adopt specialized disposal facilities to absolutely ensure
safety. So far, no official move has been seen in respect of
this hazardous practice. Last year, the Bangladesh govern-
ment collaborated with JICA to establish an incinerator
far from Dhaka City. There is lack of transportation to carry
the medical waste. The World Health Organization also
establishes two incinerators, which are now under process.
Programs should choose the disposal method that is most
appropriate for their local conditions, taking into account
cost, safety risks, and environmental regulations:
• Burying waste in a protected pit at least 2 m deep;
• Incineration, at temperatures above 800°C.
Government and public hospitals should act as the lead-
er’s models in demonstrating safe disposal of medical waste:
• Establishment of better communication and shar-
ing information about the risks from medical waste
among all shareholders (hospitals, other medical
facilities, communities, and public) is very important;
• Public awareness is necessary to animate govern-
ment policy and public demand for proper treat-
ment;
• Medical treatment trends beyond the national
boundary (eg, people from Europe, United States,
and South Asia visit India for treatment) should
also be considered and economic analysis should
be done.
There is a huge gap on medical waste management
system between different authorities and stockholders in
Bangladesh. The scientific evidence is very limited to
144 Home Health Care Management & Practice 24(3)
determine actual public health problems from medical wastes
in Bangladesh. Reduce sources reduction has higher poten-
tial to be implemented in medical waste management.
Decreased pollution control liability, regulatory and compli-
ance cost reduce threat to the general public from medical
waste. It is very important to increase awareness of hospital
staffs, employee training in hazards materials management,
and waste minimization.
Conclusions and Recommendations
Through this study, we have recommended that it is very
important to develop and implement a standard medical
waste management (MWM) policy and strategy to highlight
the management of the wastes generated at different health
care facilities. The policy should also build awareness within
hospital staff, the public, waste pickers, and Tokai about the
risks involved and proper procedures. In addition, we rec-
ommended proper in-house management, identification, and
proper segregation of materials to improve health and well-
being of involved peoples.
Institutional cooperation and government body collabo-
ration (City Corporation, DOE) may find better solutions
for proper management and treatment technology concern-
ing infectious waste; autoclaves can be introduced into
small clinics and laboratories to help with disinfections.
Government and private hospitals may establish central
incinerators system by their own human resources follow-
ing many other countries. New laws and facilities should be
established.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
  1. Jang YC, Lee C, Yoon OS, Kim H. Medical waste management
in Korea. J Environ Manage. 2006;80:107-115.
  2. Levendis Y, Atal A, Carlson J, Quintana M. PAH and soot emis-
sions from burning components of medical waste: examination/
surgical gloves and cotton pads. Chemosphere. 2001;42:775-783.
 3. World Health Organization. Basic Steps in the Preparation of
Health Care Waste Management Plans for Health Care Establish-
ments (WHO-EM/CEH/100/E/L). Amman, Jordan: Author; 2002.
  4. Karamouz M, Zahraie B, Kerachian R, Jaafarzadeh N, Mah-
jouri N. Developing a master plan for hospital solid waste man-
agement: a case study. Waste Management. 2007;27:626-638.
 5. Silva CE, Hoppe AE, Ravanello MM, Mello N. Medical
wastes management in the south Brazil. Waste Management.
2005;25:600-605.
  6. Coronel B, Durosellet P, Behrt H, Moskovtchenko JF, Freney
J. In situ decontamination of medical wastes using oxidative
agents: a 16-month study in a polyvalent intensive care unit.
J Hosp Infect. 2002;50:207-212.
 7. Chintis V, Chintis S, Vaidya K, Ravikant S, Patil S, Chintis
DS. Bacterial population changes in hospital effluent treatment
plant in central India. Water Research. 2004;38:441-447.
 8. Sabour RM, Mohamedifard A, Kamalan H. A mathematical
model to predict the composition and generation of hospital
wastes in Iran. Waste Management. 2007;27:584-587.
  9. Birpınar ME, Bilgili MS, Erdogan T. Medical waste manage-
ment in Turkey: a case study of Istanbul. Waste Management.
2008;29:445-448.
10. Muhlich M, Scherrer M, Daschner FD. Comparison of infec-
tious waste management in European hospitals. J Hosp Infect.
2003;55:260-268.
11. BAN & HCWH. Medical Waste in Developing Countries.
An Analysis With a Case Study of India, and a Critique of
the Basel-TWG Guidelines. Seattle, WA: Basel Action Network
(BAN) secretariat, Asia-Pacifice Environmental Exchange; 1999.
12. World Health organization (WHO). Medical waste. Geneva,
Switzerland: Author; 2008. Available at: http://www.who.int/
topics/medical_waste/en/. Accessed November 6, 2009.
13. World Health Organization (WHO). Safe Health Care-Waste
Management: Policy Paper. Geneva, Switzerland: Author;
2004. Available at: www.healthcarewaste.org. Accessed March
6, 2009).
14. Birchard K. Out of sight, out of mind . . . the medical waste
problem. Lancet. 2002;359:56.
15. Irina G, Ralph RN. Infectious Medical Waste Management.
Home Health Care Nurse. 1993;11:25-33.
16. Singh S, Prakash V. Toxic environmental releases from
medical waste incineration: a review. Environ Monit Assess.
2007;132:67-81.
17. Visvanathan C. Medical Waste Management Issues in Asia. In: Asia
3rd Conference, 30 October -1 November. Tokyo, Japan; 2006.
18. Patwary MA, O’Hare WT, Street G, ELahi KM, Sarker MH.
Quantitative assessment of medical waste generation in the capital
city of Bangladesh. Waste Management. 2009;29:2392-2397.
19. Hassan MM, Ahmed SA, Rahman KA, Biswas TK. Pattern of
medical waste management: existing scenario in Dhaka City,
Bangladesh. BMC Public Health. 2008;8:1-10.
20. Bangladesh Environmental Lawyers Association. The Envi-
ronmental Preservation Act 1995 (Unofficial English Version).
Dhaka, Bangladesh: Author; 1996.
21. Akter N, Kazi NM, Chowdhury MR. Medical Waste Disposal
in Dhaka City: An Environmental Evaluation (Special Publica-
tion). Dhaka, Bangladesh: International Center for Diarrhoeal
Disease Research (ICDDR, B); 1999.
22. Bangladesh Gazette. Registered No: DA-1. Ministry of Environ-
ment and Forest, Access Issue. Bangladesh: Bangladesh Forms
And Publications Office; 1997.
23. Asaduzzaman M, Hye SM. When Both Market and State Fail:
The Crisis of Solid Waste Management in Urban Bangladesh.
In Crisis in Governance. A Review of Bangladesh’s Develop-
ment. Dhaka, Bangladesh: University Press; 1997.
24. Akter N. Appropriate Management Options for Developing
Countries (the Case of Bangladesh and Thailand) [doctoral
 Syed et al. 145
dissertation]. Pathumthani, Thailand: Asian Institute of Tech-
nology; 2003.
25. Kazi NM. Waste management in Dhaka. Paper presented at:
Dhaka City Management Reform Workshop, Organized by
BRAC and Bangladesh Center for Advanced studies; March
15-17,1998; Dhaka, Bangladesh.
26. Asian Development Bank (ADB). Dhaka City Management
Reform Pilot Project, 1998. Final report Bangladesh Center for
Advanced Studies (BCAS) and BRAC, Dhaka, Bangladesh.
27. Rashid S. Medical Waste Disposal in Dhaka City: A Survey
[unpublished master’s thesis]. Dhaka, Bangladesh North-South
University; 1996.
28. World Bank. Health Care Waste Management Guidance Note.
Washington, DC: Urban Development Division, Infrastructure
Group, Environment Department and Health, Nutrition and
Population Team, World Bank; 2000.
29. Tickner JA, Schettler T, Guidotti T, McCally M, Rossi M.
Health risks posed by use of Di-2-Ethylhexyl Phthalate (DEHP)
in PVC Medical Devices: A critical review. Am J Ind Med.
2001;39:100-111.
30. World Health Organization. Wastes From Health-Care Activi-
ties (WHO Information Fact Sheet, 2000, No. 253). Geneva,
Switzerland: Author; 2007. Available at: www.who.int/inf-fs/
en/fact253.html. Accessed June 10, 2010.
View publication stats
31. Hutin Y, Hauri A, Armstrong GL. Use of injections in health-
care settings worldwide, 2000: literature review and regional
estimates. BMJ. 2003;327:1075.
32. Hauri AM, Armstrong GL, Hutin YJF. The global burden of dis-
ease attributable to contaminated injections given in health care
settings. Int J STD AIDS. 2004;15:7-16.
33. Akter N, Kazi NM, Chowdhury MR. Environmental Investiga-
tion of Medical Waste Management Systemic Bangladesh With
Special Reference to Dhaka City. Mohakhali, Dhaka, Bangla-
desh: BRAC, Research and Evaluation Division; 2000.
34. Valanis BG, Vollmer WM, Steele P. Occupational exposure
to antineoplastic agents: self-reported miscarriages and still
birth among nurses and pharmacists. J Occup Environ Med.
1999;41:192-200.
35. Akter N. Hospital waste management and its probable health
effect: a lesson from Bangladesh. Indian J Environ Health.
2002;44:124-137.
36. Aborjona O Poribesh. A newsletter on waste management
and recycling in Bangladesh. September 2000. Available at:
http://www.wasteconcern.org/newsletters/issue5/issue5.html.
Accessed September 27, 2011.
37. Available at: http://www.ittefaq.tv/dailynews/feb08/1902083.
html. Accessed September 27, 2011.
38. Photos taken by the first author.