Extreme weather and sanitation in Bangladesh: a mixed-methods study of lived experiences of people with disabilities.

Background: Climate change exacerbates weather extremes, damaging sanitation infrastructure and undermining personal hygiene. Disasters disproportionately impact people with disabilities. This study explored how flooding and cyclones affect the sanitation experiences of people with disabilities in Bangladesh. Methods: This mixed-methods study comprised a cross-sectional survey, in-depth interviews, and photovoice. Survey data was collected from 1021 people with disabilities and 909 without disabilities. Purposive sampling selected 28 people with disabilities and 16 caregivers for qualitative data collection. Data were analysed using descriptive statistics, multi-level Poisson regression, and thematic analysis. Findings: People with disabilities had a modestly higher risk of experiencing sanitation damage by cyclones or floods compared to people without disabilities (adjusted risk ratio [aRR] 1.28, 95% CI 1.00-1.63). Among people with disabilities, those in the wealthiest quintile were 88% less likely to experience sanitation facility damage than those in the poorest quintile. Qualitative findings showed that muddy, inaccessible paths caused injuries to people with disabilities and their caregivers. Accessing alternative facilities during flooding was difficult for persons with disabilities, with some experiencing verbal abuse. Some reported resorting to open defecation. People with disabilities with incontinence often could not reach facilities in time, resulting in soiled clothing and bedding. Privacy concerns and reliance on caregivers led many, especially women, to restrict toileting, while both women and men adjusted food and water intake, increasing health risks. Interpretation: Flooding and storms worsen sanitation challenges for people with disabilities and caregivers, increasing injury risk, dependence, and exposure to human waste. Climate-resilient sanitation must prioritise inclusive sanitation to protect dignity, health, and well-being, and prevent the deepening of health inequalities. Funding: Australian Government's Water for Women (WfW) Fund.