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New Directions in Water, Sanitation and Hygiene Research

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environment and Applied Ecology".

Deadline for manuscript submissions: closed (30 June 2020) | Viewed by 72096

Special Issue Editors

Dr. Matthew Freeman

E-Mail Website
Guest Editor
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Interests: global health; infectious disease; safe water and sanitation; environmental health; epidemiology
Prof. Thomas F. Clasen

E-Mail Website
Guest Editor
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Interests: Evaluation; Global Health; Health Outcomes; Infectious Disease; Safe Water and Sanitation; Air Pollution

Special Issue Information

Dear Colleagues,

The Sustainable Development Goals create ambitious targets for achieving universal basic sanitation and water supply in communities, schools and health facilities. They also address shortcomings in previous targets by focusing directly on drinking water quality and the entire waste management stream.

Recent trials in low-income settings, however, have raised questions about the impact of some “legacy” water, sanitation, and hygiene (WASH) interventions. While some of these results may be attributable to programmatic shortcomings leading to poor coverage and uptake, rigorous efficacy trials have also reported disappointing results. Hypotheses about the potential for improved WASH to reduce stunting have found inconsistent support in field studies. Rigorous experimental evidence to support the impact of WASH on other outcomes of health and wellbeing is limited. 

In this issue, we explore “New Directions in WASH Research” that could catalyze the achievement of and go beyond the SDG targets to transform the health and livelihoods of the poorest. We will explore novel intervention developments, evaluation, and measurement ideas and methods that expand the WASH approaches currently being implemented in the global South and enable the development and evaluation of more effective, efficient and impactful WASH interventions.

Papers may explore:

  • Innovations to assess exposure to fecal pathogens, under-investigated transmission pathways such as food and animals, and the role of WASH in mitigating antimicrobial resistance.
  • Novel strategies for implementation, including WASH improvements that use systems approaches and create synergies across sectors or that employ strategies to advance individual empowerment and community efficacy.
  • Alternative outcomes potentially associated with poor WASH conditions, including child learning and development, patient outcomes at health facilities, sustainable control of WASH-related neglected tropical diseases, co-infections, inflammation, nutrition and longer term health and economic effects.

Creative approaches, rigorous evaluations, and innovative methods will be required to achieve the SDGs, but also to transform WASH access among the global poor.

Dr. Matthew C. Freeman
Prof. Thomas F. Clasen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (17 papers)

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17 pages, 2120 KiB  
Article
The Sustainability and Scalability of Private Sector Sanitation Delivery in Urban Informal Settlement Schools: A Mixed Methods Follow Up of a Randomized Trial in Nairobi, Kenya
by Jedidiah S. Snyder, Graeme Prentice-Mott, Charles Boera, Alex Mwaki, Kelly T. Alexander and Matthew C. Freeman
Int. J. Environ. Res. Public Health 2020, 17(15), 5298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155298 - 23 Jul 2020
Cited by 2 | Viewed by 2406
Abstract
There are considerable challenges to achieving the Sustainable Development Goals’ target of universal access to basic sanitation in schools. Schools require safe, clean, and sex-segregated facilities for a large number of students. Robust and affordable solutions are needed to address the economic, spatial, [...] Read more.
There are considerable challenges to achieving the Sustainable Development Goals’ target of universal access to basic sanitation in schools. Schools require safe, clean, and sex-segregated facilities for a large number of students. Robust and affordable solutions are needed to address the economic, spatial, social, institutional, and political factors which contribute to poor sanitary conditions in informal settlements. In 2015, we undertook a randomized controlled trial to assess the feasibility of private sector sanitation delivery (PSSD) in 20 primary schools, in informal settlements of Nairobi, Kenya. Our preliminary evaluation after one year of service delivery suggested that PSSD of urine-diverting dry latrines with routine waste collection and maintenance provided a feasible, lower-cost alternative to the government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. We conducted a mixed-methods follow-up study to assess sanitation delivery over 3–4 years and investigate prevailing drivers and barriers that may influence the scalability of PSSD. The conditions of newly constructed and rehabilitated GSD facilities diminished quickly, reverting to the conditions of existing facilities, indicating lower sustainability compared to sanitation delivered from the private sector. Barriers in financial aspects related to the ongoing implementation of PSSD emerged, particularly among public schools, and few were able to pay for continued service. Our study demonstrates that the engagement of the private sector may lead to improvements in affordable, safely managed sanitation for schools and their students. Yet, to reach a sustained scale, additional guidance is needed on how to develop these partnerships, streamline procurement and contracting processes, and incorporate appropriate financing mechanisms. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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16 pages, 358 KiB  
Article
Community Perceptions of a Multilevel Sanitation Behavior Change Intervention in Rural Odisha, India
by Renee De Shay, Dawn L. Comeau, Gloria D. Sclar, Parimita Routray and Bethany A. Caruso
Int. J. Environ. Res. Public Health 2020, 17(12), 4472; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124472 - 22 Jun 2020
Cited by 6 | Viewed by 2451
Abstract
While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along [...] Read more.
While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along with specific impressions and spillover of community-level activities of the Sundara Grama latrine use behavior change intervention in rural Odisha, India. We conducted sixteen sex-segregated focus group discussions (n = 152) in three intervention and three nonintervention villages and thematically analyzed the data. We found Sundara Grama was well-received by community members and considered educative, but perceptions of impact on latrine use were mixed and varied by activity. Intervention recruitment challenges prevented some, such as women and households belonging to lower castes, from attending activities. Spillover occurred in one of two nonintervention villages, potentially due to positive relations within and between the nonintervention village and nearby intervention village. Community-level sanitation initiatives can be hindered by community divisions, prioritization of household sanitation over community cleanliness, and perceptions of latrine use as a household and individual issue, rather than common good. Community-centered sanitation interventions should assess underlying social divisions, norms, and perceptions of collective efficacy to adapt intervention delivery and activities. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
10 pages, 1554 KiB  
Article
Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique
by Frederick G. B. Goddard, Jacqueline Knee, Trent Sumner, Rassul Nalá, Thomas Clasen and Joe Brown
Int. J. Environ. Res. Public Health 2020, 17(9), 3035; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17093035 - 27 Apr 2020
Cited by 3 | Viewed by 2271
Abstract
Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising [...] Read more.
Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections −0.04 log μg/mL (95% confidence interval (CI): −0.08 to −0.005 log μg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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14 pages, 2425 KiB  
Article
Multidimensional Benefits of Improved Sanitation: Evaluating ‘PEE POWER®’ in Kisoro, Uganda
by Jiseon You, Chad Staddon, Alan Cook, James Walker, Jess Boulton, Wayne Powell and Ioannis Ieropoulos
Int. J. Environ. Res. Public Health 2020, 17(7), 2175; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072175 - 25 Mar 2020
Cited by 11 | Viewed by 3584
Abstract
With 2.3 billion people around the world lacking adequate sanitation services, attention has turned to alternative service provision models. This study suggests an approach for meeting the sanitation challenge, especially as expressed in Sustainable Development Goal 6.2, using a toilet technology system, such [...] Read more.
With 2.3 billion people around the world lacking adequate sanitation services, attention has turned to alternative service provision models. This study suggests an approach for meeting the sanitation challenge, especially as expressed in Sustainable Development Goal 6.2, using a toilet technology system, such as Pee Power® that generates electricity using diverted urine as a fuel. A field trial was carried out in a girls’ school in Kisoro, Uganda, where the generated electricity was used to light the existing toilet block. The trial was evaluated in terms of social acceptability and user experience using a multidimensional assessment protocol. The results of our assessment show that users felt safer when visiting the toilets at night. Lights provided from the technology also helped with the perceived cleanliness of the toilets. The technology was well accepted, with 97% of the respondents saying that they liked the idea of the Pee Power® technology and 94% preferring it over other facilities on site. This shows how the technology helps meet SDG target 6.2, with its particular focus on vulnerable populations. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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13 pages, 1128 KiB  
Article
Solar Powered Microplasma-Generated Ozone: Assessment of a Novel Point-of-Use Drinking Water Treatment Method
by Samuel Dorevitch, Kendall Anderson, Abhilasha Shrestha, Dorothy Wright, Aloyce Odhiambo, Jared Oremo and Ira Heimler
Int. J. Environ. Res. Public Health 2020, 17(6), 1858; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17061858 - 13 Mar 2020
Cited by 10 | Viewed by 3659
Abstract
Ozonation is widely used in high-income countries for water disinfection in centralized treatment facilities. New microplasma technology has reduced the energy requirements for ozone generation dramatically, such that a 15-watt solar panel is sufficient to produce small quantities of ozone. This technology has [...] Read more.
Ozonation is widely used in high-income countries for water disinfection in centralized treatment facilities. New microplasma technology has reduced the energy requirements for ozone generation dramatically, such that a 15-watt solar panel is sufficient to produce small quantities of ozone. This technology has not been used previously for point-of-use drinking water treatment. We conducted a series of assessments of this technology, both in the laboratory and in homes of residents of a village in western Kenya, to estimate system efficacy and to determine if the solar-powered point-of-use water ozonation system appears safe and acceptable to end-users. In the laboratory, two hours of point-of-use ozonation reduced E. coli in 120 L of wastewater by a mean (standard deviation) of 2.3 (0.84) log-orders of magnitude and F+ coliphage by 1.54 (0.72). Based on laboratory efficacy, 10 families in Western Kenya used the system to treat 20 L of household stored water for two hours on a daily basis for eight weeks. Household stored water E. coli concentrations of >1000 most probable number (MPN)/100 mL were reduced by 1.56 (0.96) log removal value (LRV). No participants experienced symptoms of respiratory or mucous membrane irritation. Focus group research indicated that families who used the system for eight weeks had very favorable perceptions of the system, in part because it allowed them to charge mobile phones. Drinking water ozonation using microplasma technology may be a sustainable point-of-use treatment method, although system optimization and evaluations in other settings would be needed. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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23 pages, 1341 KiB  
Article
Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries
by Paschal A. Apanga, Joshua V. Garn, Zoe Sakas and Matthew C. Freeman
Int. J. Environ. Res. Public Health 2020, 17(5), 1808; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17051808 - 10 Mar 2020
Cited by 12 | Viewed by 7060
Abstract
Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, [...] Read more.
Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity—if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups—we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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18 pages, 1832 KiB  
Article
System Approaches to Water, Sanitation, and Hygiene: A Systematic Literature Review
by Nicholas Valcourt, Amy Javernick-Will, Jeffrey Walters and Karl Linden
Int. J. Environ. Res. Public Health 2020, 17(3), 702; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17030702 - 21 Jan 2020
Cited by 34 | Viewed by 9477
Abstract
Endemic issues of sustainability in the water, sanitation, and hygiene (WASH) sector have led to the rapid expansion of ‘system approaches’ for assessing the multitude of interconnected factors that affect WASH outcomes. However, the sector lacks a systematic analysis and characterization of the [...] Read more.
Endemic issues of sustainability in the water, sanitation, and hygiene (WASH) sector have led to the rapid expansion of ‘system approaches’ for assessing the multitude of interconnected factors that affect WASH outcomes. However, the sector lacks a systematic analysis and characterization of the knowledge base for systems approaches, in particular how and where they are being implemented and what outcomes have resulted from their application. To address this need, we conducted a wide-ranging systematic literature review of systems approaches for WASH across peer-reviewed, grey, and organizational literature. Our results show a myriad of methods, scopes, and applications within the sector, but an inadequate level of information in the literature to evaluate the utility and efficacy of systems approaches for improving WASH service sustainability. Based on this analysis, we propose four recommendations for improving the evidence base including: diversifying methods that explicitly evaluate interconnections between factors within WASH systems; expanding geopolitical applications; improving reporting on resources required to implement given approaches; and enhancing documentation of effects of systems approaches on WASH services. Overall, these findings provide a robust survey of the existing landscape of systems approaches for WASH and propose a path for future research in this emerging field. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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23 pages, 2075 KiB  
Article
Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households
by Latifah Hamzah, Alexandria B. Boehm, Jennifer Davis, Amy J. Pickering, Marlene Wolfe, Maryanne Mureithi and Angela Harris
Int. J. Environ. Res. Public Health 2020, 17(2), 608; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17020608 - 17 Jan 2020
Cited by 8 | Viewed by 4287
Abstract
In sub-Saharan Africa, many families travel to collect water and store it in their homes for daily use, presenting an opportunity for the introduction of fecal contamination. One stored and one source water sample were each collected from 45 households in rural Kenya. [...] Read more.
In sub-Saharan Africa, many families travel to collect water and store it in their homes for daily use, presenting an opportunity for the introduction of fecal contamination. One stored and one source water sample were each collected from 45 households in rural Kenya. All 90 samples were analyzed for fecal indicator bacteria (E. coli and enterococci) and species-specific contamination using molecular microbial source tracking assays. Human (HF183), avian (GFD), and ruminant (BacR) contamination were detected in 52, two, and four samples, respectively. Stored water samples had elevated enterococci concentrations (p < 0.01, Wilcoxon matched pairs test) and more frequent BacR detection (89% versus 27%, p < 0.01, McNemar’s exact test) relative to source water samples. fsQCA (fuzzy set qualitative comparative analysis) was conducted on the subset of households with no source water BacR contamination to highlight combinations of factors associated with the introduction of BacR contamination to stored water supplies. Three combinations were identified: (i) ruminants in the compound, safe water extraction methods, and long storage time, (ii) ruminants, unsafe water extraction methods, and no soap at the household handwashing station, and (iii) long storage time and no soap. This suggests that multiple pathways contribute to the transmission of ruminant fecal contamination in this context, which would have been missed if data were analyzed using standard regression techniques. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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18 pages, 775 KiB  
Article
Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools
by Allison P. Salinger, Gloria D. Sclar, James Dumpert, Davin Bun, Thomas Clasen and Maryann G. Delea
Int. J. Environ. Res. Public Health 2020, 17(1), 1; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17010001 - 18 Dec 2019
Cited by 7 | Viewed by 3242
Abstract
Community-level action may be required to achieve the levels of sanitation uptake necessary for health gains. Evidence suggests that collective action is influenced by collective efficacy (CE)—a group’s belief in its abilities to organize and execute action to achieve common goals. The extent [...] Read more.
Community-level action may be required to achieve the levels of sanitation uptake necessary for health gains. Evidence suggests that collective action is influenced by collective efficacy (CE)—a group’s belief in its abilities to organize and execute action to achieve common goals. The extent to which it is necessary to fully contextualize existing CE measurement tools, in order to conduct meaningful assessments of the factors influencing CE perceptions, is not well understood. This study examines the value added of contextualizing an existing CE measurement tool using qualitative formative research. We employed a modified grounded theory approach to develop a contextualized CE framework based on qualitative data from rural Cambodian villages. The resulting framework included sub-constructs that were pertinent for the rural Cambodian context for which an existing, hypothesized framework did not account: perceived risks/benefits, action knowledge, shared needs/benefits, and external accountability. Complex confirmatory factor analyses indicated that contextualized models fit the data better than hypothesized models for women and men. This study demonstrates that inductive, qualitative research allows community-derived factors to enhance existing tools for context-specific CE measurement. Additional research is needed to determine which CE factors transcend contexts and could, thus, form the foundation of a general CE measurement tool. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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11 pages, 730 KiB  
Article
Occupational Exposure to Endotoxin along a Municipal Scale Fecal Sludge Collection and Resource Recovery Process in Kigali, Rwanda
by Rachel Sklar, Zeyi Zhou, Marley Zalay, Ashley Muspratt and S. Katharine Hammond
Int. J. Environ. Res. Public Health 2019, 16(23), 4740; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16234740 - 27 Nov 2019
Cited by 1 | Viewed by 2247
Abstract
Background: Little is known about occupational exposures that occur along fecal sludge collection and resource recovery processes. This study characterizes inhaled endotoxin exposure to workers of a municipal scale fecal sludge-to-fuel processes in Kigali, Rwanda. Methods: Forty-two task-based air samples were [...] Read more.
Background: Little is known about occupational exposures that occur along fecal sludge collection and resource recovery processes. This study characterizes inhaled endotoxin exposure to workers of a municipal scale fecal sludge-to-fuel processes in Kigali, Rwanda. Methods: Forty-two task-based air samples were collected from workers in five tasks along the fecal sludge collection and resource recovery process. Samples were processed for endotoxin using the limulus amebocyte lysate (LAL) test. To account for exposure variability and compare measured concentrations to established exposure limits, we used Monte Carlo modeling methods to construct distributions representing full eight-hour (8-h) exposures to endotoxin across eight exposure scenarios. Results: Geometric mean (GM) endotoxin concentrations in task-based samples ranged from 11–3700 EU/m3 with exposure concentrations increasing as the dryness of the fecal sludge increased through processing. The thermal dryer task had the highest endotoxin concentrations (GM = 3700 EU/m3) and the inlet task had the lowest (GM = 11 EU/m3). The geometric means (GM) of modeled 8-h exposure concentrations were between 6.7–960 EU/m3 and highest for scenarios which included the thermal dryer task in the exposure scenario. Conclusions: Our data suggest the importance of including worker exposure considerations in the design of nascent fecal sludge management processes. The methods used in this study combine workplace sampling with stochastic modeling and are useful for exposure assessment in resource constrained contexts. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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18 pages, 909 KiB  
Article
Costs and Willingness to Pay for Pit Latrine Emptying Services in Kigali, Rwanda
by Zachary Burt, Rachel Sklar and Ashley Murray
Int. J. Environ. Res. Public Health 2019, 16(23), 4738; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16234738 - 27 Nov 2019
Cited by 16 | Viewed by 5787
Abstract
Kigali, Rwanda lacks a centralized sewer system, which leaves residents to choose between on-site options; the majority of residents in informal settlements use pit latrines as their primary form of sanitation. When their pits fill, the pits are either sealed, or emptied; emptying [...] Read more.
Kigali, Rwanda lacks a centralized sewer system, which leaves residents to choose between on-site options; the majority of residents in informal settlements use pit latrines as their primary form of sanitation. When their pits fill, the pits are either sealed, or emptied; emptying is often done by hand and then dumped in the environment, putting the residents and the broader population at risk of infectious disease outbreaks. In this paper, we used revealed and stated preference models to: (1) estimate the demand curve for improved emptying services; and, (2) evaluate household preferences and the willingness to pay (WTP) for different attributes of improved emptying services. We also quantify the costs of improved service delivery at different scales of production. The study included 1167 households from Kigali, Rwanda across 30 geographic clusters. Our results show that, at a price of US$79 per pit, 15% of all the pits would be emptied by improved emptying services, roughly the current rate of manual emptying. Grouping empties by neighborhood and ensuring that each truck services an average of four households per day could reduce the production costs to US$44 per empty, ensuring full cost coverage at that price. At a lower price of US$24, we estimate that the sealing of pits might be fully eliminated, with full coverage of improved emptying services for all pits; this would require a relatively small subsidy of US$20 per empty. Our results show that households had strong preferences for fecal sludge (FS) treatment, formalized services (which include worker protections), and distant disposal. The results from the study indicate a few key policies and operational strategies that can be used for maximizing the inclusion of low-income households in safely managed sanitation services, while also incorporating household preferences and participation. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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15 pages, 812 KiB  
Article
What If Your Husband Doesn’t Feel the Pressure? An Exploration of Women’s Involvement in WaSH Decision Making in Nyanchwa, Kenya
by Thelma Zulfawu Abu, Elijah Bisung and Susan J. Elliott
Int. J. Environ. Res. Public Health 2019, 16(10), 1763; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16101763 - 18 May 2019
Cited by 9 | Viewed by 4283
Abstract
Access to water, sanitation and hygiene (WaSH) is a major challenge in sub-Saharan Africa (SSA). Women and girls suffer the main burden of a lack of access to WaSH because they are primarily responsible for collecting water for their homes. However, they are [...] Read more.
Access to water, sanitation and hygiene (WaSH) is a major challenge in sub-Saharan Africa (SSA). Women and girls suffer the main burden of a lack of access to WaSH because they are primarily responsible for collecting water for their homes. However, they are often excluded from WaSH decision-making and implementation processes. This research sought to explore women’s experiences in participating in WaSH decision-making through a case study in Nyanchwa, Kenya. Twelve (12) key informant interviews were conducted with community leaders and members regarding challenges and possible measures for enhancing women and girls’ participation in WaSH decision-making. From this research, it is evident that economic challenges and cultural factors such as male dominance, greatly inhibit women and girls’ participation in WaSH decision-making and implementation processes. Other factors such as time constraints and low literacy rates also emerged. The paper concludes with a call for collaboration among women’s groups to enhance collective action for improved access to WaSH. This will undoubtedly lead to enhanced community health and wellbeing (Sustainable Development Goal 3, SDG3) through the empowerment of women (Sustainable Development Goal 5, SDG5). Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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19 pages, 2044 KiB  
Article
Agent-Based Modelling for Simulation-Based Design of Sustainable Faecal Sludge Management Systems
by Adrian Mallory, Martin Crapper and Rochelle H. Holm
Int. J. Environ. Res. Public Health 2019, 16(7), 1125; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16071125 - 28 Mar 2019
Cited by 8 | Viewed by 4637
Abstract
Re-using faecal sludge (FS) to generate value has the potential to contribute towards solving the issue of long term sanitation solutions in growing urban areas across sub-Saharan Africa; however, hitherto, no design tools have been available that are capable of simulating a system [...] Read more.
Re-using faecal sludge (FS) to generate value has the potential to contribute towards solving the issue of long term sanitation solutions in growing urban areas across sub-Saharan Africa; however, hitherto, no design tools have been available that are capable of simulating a system involving economic factors, complex social issues and environmental circumstances. We hypothesized that Agent-Based Modelling (ABM), when deployed with appropriate rigour, can provide such a tool. Extensive field work was carried out in a Malawian city, investigating the adoption of Skyloo above-ground composting toilets by households, and the operation of the municipal FS site. 65 semi-structured interviews and 148 household interviews, together with observations, were carried out to characterize these processes, with the data acquired being used to construct two separate ABMs. The Skyloo ABM was run for various scenarios of start-up capital for business and payback of loans against the toilet cost to households. The municipal FS Site ABM was run for different patterns of dumping fee and enforcement structure. The field work demonstrated that there is potential for further expansion of FS reuse, with a market for agricultural application. The Skyloo ABM identified the significance of start-up capital for a business installing the toilet technology; the municipal FS Site ABM showed that existing fees, fines and regulatory structure were insufficient to reduce illegal dumping of FS to any useful degree, but that a monthly permit system would provide enhanced revenue to the city council compared with per-visit charging of disposal companies at the municipal FS site. Whilst each ABM ideally requires some additional data before full application, we have, for the first time, shown that ABM provides a basis for the simulation-based design of FS management systems, including complex social, economic and environmental factors. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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13 pages, 1335 KiB  
Article
Sustainable Sanitation Management Tool for Decision Making in Isolated Areas in Brazil
by Fernando J. C. Magalhães Filho, Adriane A. F. S. L. de Queiroz, Beatriz S. Machado and Paula L. Paulo
Int. J. Environ. Res. Public Health 2019, 16(7), 1118; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16071118 - 28 Mar 2019
Cited by 9 | Viewed by 4489
Abstract
There is a worldwide range of technical sanitation guidelines focusing on small or traditional and isolated communities for ecological alternatives at the household level. However, a computational tool (software) that has a database and connects these guidelines in a single reference for resource-oriented [...] Read more.
There is a worldwide range of technical sanitation guidelines focusing on small or traditional and isolated communities for ecological alternatives at the household level. However, a computational tool (software) that has a database and connects these guidelines in a single reference for resource-oriented sanitation concept decision making is still lacking. In this regard, an easy-to-use tool was developed using a participatory approach for the decision-making process from a choice of technical solutions to a type of system management. The results obtained from a pilot study indicate that the proposed tool in this paper will help with the decision-making process to aid in not only choosing sustainable sanitation solutions, but also sustainable operation and maintenance options for the systems. When presenting and discussing the tool with research groups and technicians, the potential for participatory application was noticed. The proposed tool can be used in the elaboration of municipal sanitation plans, assisting local technicians and environmental licensing agencies, designers and engineering students, among others. The software can be applied with other management tools, such as 5W2H and Canvas business model. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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14 pages, 311 KiB  
Article
Sanitation in Rural India: Exploring the Associations between Dwelling Space and Household Latrine Ownership
by Anoop Jain, Lia C.H. Fernald, Kirk R. Smith and S.V. Subramanian
Int. J. Environ. Res. Public Health 2019, 16(5), 734; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16050734 - 28 Feb 2019
Cited by 9 | Viewed by 3136
Abstract
In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this [...] Read more.
In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
16 pages, 714 KiB  
Article
Enteric Pathogen Diversity in Infant Foods in Low-Income Neighborhoods of Kisumu, Kenya
by Kevin Tsai, Sheillah Simiyu, Jane Mumma, Rose Evalyne Aseyo, Oliver Cumming, Robert Dreibelbis and Kelly K. Baker
Int. J. Environ. Res. Public Health 2019, 16(3), 506; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030506 - 12 Feb 2019
Cited by 22 | Viewed by 4020
Abstract
Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. [...] Read more.
Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 infant weaning foods in Kisumu, Kenya, using a multi-pathogen PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoan enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow’s milk was significantly more likely to contain a pathogen (adjusted risk ratio = 14.4; 95% confidence interval (CI) 1.78–116.1) and more likely to have higher number of enteric pathogen species (adjusted risk ratio = 2.35; 95% CI 1.67–3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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Review

Jump to: Research

35 pages, 1281 KiB  
Review
Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens
by Jesse D. Contreras and Joseph N.S. Eisenberg
Int. J. Environ. Res. Public Health 2020, 17(1), 230; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17010230 - 28 Dec 2019
Cited by 8 | Viewed by 4332
Abstract
Three of four recent major sanitation intervention trials found no effect on diarrhea. These results conflicted with longstanding beliefs from decades of literature. To understand this discordance, we placed recent trials into the historical context that preceded them in two ways. First, we [...] Read more.
Three of four recent major sanitation intervention trials found no effect on diarrhea. These results conflicted with longstanding beliefs from decades of literature. To understand this discordance, we placed recent trials into the historical context that preceded them in two ways. First, we evaluated the history of published literature reviews on sanitation and diarrhea. Second, we conducted meta-analyses on studies from the most recent systematic review to uncover features that predict effectiveness. We found that 13 literature reviews dating to 1983 consistently estimated a significant protective effect of sanitation against diarrhea. However, these were marred by flawed studies and inappropriately averaged effects across widely heterogeneous interventions and contexts. Our meta-analyses highlight that the overall effect of sanitation on diarrhea was largely driven by sewerage and interventions that improved more than sanitation alone. There is no true overall effect of sanitation because variability between intervention types and implementation contexts is too complex to average. Ultimately, the null effects of recent latrine interventions are not surprising. Instead, the one trial that found a strong relative reduction in diarrhea is the historical outlier. The development of transformative sanitation interventions requires a better understanding of the social and environmental contexts that determine intervention effectiveness. Full article
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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