Assessment of Biomedical Waste Management, Segregation Compliance and Disposal Practices in Public Hospitals of Charsadda District, Khyber Pakhtunkhwa, Pakistan

The management of biomedical waste is a crucial public health concern; however, few studies have assessed the situation at the district level in Pakistan. This study assessed and compared biomedical waste management (BWM) practices across three public hospitals in Charsadda District, Khyber Pakhtunkhwa, Pakistan. A cross-sectional descriptive assessment was conducted during the fourth week of February 2025 at the District Headquarters Hospital (DHQ) Charsadda, the Women and Children Hospital (WCH) Charsadda, and the Tehsil Headquarters Hospital (THQ) Tangi. The assessment employed structured questionnaires administered to healthcare workers (HCWs n = 90 across three facilities: DHQ = 35; WCH = 30; THQ = 25), observational checklists, key-informant interviews with waste management officers, and retrospective hospital waste records. Descriptive statistics and cross-facility comparisons were used for analysis. Monthly waste generation was highest at DHQ Charsadda (900 kg; 580 beds), followed by WCH (600 kg; 450 beds) and THQ Tangi (500 kg; 350 beds). The waste composition at DHQ comprised general waste (38%), infectious waste (36%), pharmaceutical waste (10%), pathological waste (8%), and sharps waste (8%). At WCH, 40% was general waste, 25% infectious, 15% pathological, 10% pharmaceutical, and 10% sharps. THQ Tangi lacked detailed composition data. Segregation compliance varied considerably: WCH achieved greater than 90% compliance across departments, DHQ ranged from 50% to 90% depending on the department, and THQ Tangi had no functional segregation system. At WCH, 60% of waste was disposed of through licensed incineration, whereas open dumping without pre-treatment was the primary method at THQ Tangi. Approximately 90% of staff at WCH had received formal BWM training compared with 30% at DHQ and 40% at THQ Tangi. The main barriers reported at THQ Tangi were lack of resources (50%), weak regulations (30%), and lack of awareness (20%). Considerable variation was observed among the three hospitals in BWM practices, with THQ Tangi demonstrating the weakest performance in segregation and treatment, and WCH displaying comparatively stronger practices in training and compliance.