Healthcare waste generation and management risk assessment across ten facilities in Gaibandha Bangladesh

Improper healthcare waste (HCW) management in resource-constrained municipalities creates environmental exposure pathways, yet quantitative risk-monitoring data from secondary urban centers in Bangladesh remain limited. This cross-sectional observational study integrated waste quantification, compositional analysis, compliance assessment, and multi-dimensional environmental risk profiling across 10 healthcare establishments (302 beds; five government and five private facilities) in Gaibandha Municipality, Bangladesh, from August to October 2023. Waste from three consecutive 24-hour collection periods per facility was segregated into eight categories and weighed using a calibrated digital scale (±0.01 kg). Waste-management performance and risk across seven domains were assessed through facility observations and structured interviews. Mean HCW generation was 1.344 ± 0.298 kg bed⁻ 1 day⁻ 1 (95% confidence interval [CI]: 1.130–1.557) and 1.620 ± 0.458 kg patient⁻ 1 day⁻ 1 (95% CI: 1.292–1.948), with no statistically significant government–private differences (independent t-tests; all p > 0.05). Within this municipal sample, patient census explained 97.2% of the variation in total waste generation (Waste = 16.97 + 0.675 × Patients; R 2 = 0.972; p < 0.001), indicating its preliminary potential as a planning variable while requiring validation in larger and seasonally stratified samples. Organic waste dominated the stream (82.6%; 918.8 kg over 30 facility-days), while the operationally classified potentially hazardous fraction was 17.4%, slightly exceeding the World Health Organization (WHO) estimate of approximately 15%; however, low verified segregation limits interpretation of this fraction. The study-defined Multi-Dimensional Risk Score (MDRS) classified four domains as CRITICAL (Risk Gap Index ≥ 6.0) and three as HIGH; overall verified compliance across the eight core indicators was only 21.6%. Observed domain risk scores exceeded the indicative author-assigned benchmark scores derived from WHO guidance (Wilcoxon signed-rank test, p = 0.022). These findings indicate widespread HCW management weaknesses across the sampled facilities and support targeted interventions in flood-prone municipalities where inadequate storage and co-collection of untreated HCW with municipal waste may increase exposure risks during monsoon high-flow events.