Community Faecal Management Strategies and Perceptions on Sludge Use in Agriculture

Most people in rural areas in South Africa (SA) rely on untreated drinking groundwater sources and pit latrine sanitations. A minimum basic sanitation facility should enable safe and appropriate removal of human waste, and although pit latrines provide this, they are still contamination concerns. Pit latrine sludge in SA is mostly emptied and disposed off-site as waste or buried in-situ. Despite having knowledge of potential sludge benefits, most communities in SA are reluctant to use it. This research captured social perceptions regarding latrine sludge management in Monontsha village in the Free State Province of SA through key informant interviews and questionnaires. A key informant interview and questionnaire was done in Monontsha, SA. Eighty participants, representing 5% of all households, were selected. Water samples from four boreholes and four rivers were analyzed for faecal coliforms and E. coli bacteria. On average, five people in a household were sharing a pit latrine. Eighty-three percent disposed filled pit latrines while 17% resorted to closing the filled latrines. Outbreaks of diarrhoea (69%) and cholera (14%) were common. Sixty percent were willing to use treated faecal sludge in agriculture. The binary logistic regression model indicated that predictor variables significantly (p ˂ 0.05) described water quality, faecal sludge management, sludge application in agriculture and biochar adaption. Most drinking water sources in the study had detections ˂1 CFU/100 mL. It is therefore imperative to use both qualitative surveys and analytical data. Awareness can go a long way to motivate individuals to adopt to a new change.


Introduction
Globally, governments have a critical role to ensure quality provision of water and sanitation access to their citizens [1]. Water and sanitation are basic necessities for development worldwide [2]. In developing countries, such as South Africa (SA), most people in rural areas rely on untreated drinking groundwater sources [3] and pit latrine sanitations [4,5].
South Africa has a number of outstanding sanitation needs [6]. These were categorized in terms of backlogs of service delivery, refurbishment and extension, upgrade needs, and operation and maintenance [6]. The Department of Water and Sanitation (DWS) found adverse gaps on the access to water and sanitation, mainly in the most disadvantaged communities in SA [4,6]. The disintegration This research aimed to capture social perceptions regarding latrine sludge management and perceived water quality, as well as perception on treated faecal sludge use in agriculture. The sociological survey is supplemented with physical measurements of organic pollution of water resources in the study area.

Location of the Study
The field study and surveys were conducted in the eastern Free State, South Africa (Figure 1). The study sites are located in Monontsha, a rural village of Maluti-a-Phofung local municipality, Thabo Mofutsanyana District Municipality (−28.554257, 28.722113), which formed part of the former QwaQwa homeland. The site covers an area of 8.06 km 2 , with a population of 5552 (688.63 per km 2 ) and 1552 (192.25 per km 2 ) households [30]. Only households relying on Ventilated Improved Pit latrines (VIP) and Un-Improved Pit latrine (UN-IP) sanitations were included in the sociological surveys. The field study and surveys were conducted in the eastern Free State, South Africa ( Figure 1). The study sites are located in Monontsha, a rural village of Maluti-a-Phofung local municipality, Thabo Mofutsanyana District Municipality (-28.554257, 28.722113), which formed part of the former QwaQwa homeland. The site covers an area of 8.06 km 2 , with a population of 5552 (688.63 per km 2 ) and 1552 (192.25 per km 2 ) households [30]. Only households relying on Ventilated Improved Pit latrines (VIP) and Un-Improved Pit latrine (UN-IP) sanitations were included in the sociological surveys.

Field Study
A key informant interview and questionnaire based on guided questions was done with 10 community leaders (Chief and his council) and residents in the area. The pre-test was used to refine and enhance validity of the questionnaire. A similar approach to the Sanitation Focus Opportunity Ability and Motivation (SaniFOAM) framework [31] was used. The framework analyzes sanitation behaviors to design effective sanitation programs. In the study, 80 participants representing five percent of all households [30] were selected. The key informants provided general information on the management of waste from pit latrines. The information from the key informants was then fitted into a structured questionnaire survey which was used to probe what the communities do when the pit latrines fill up and whether they would be willing to reuse treated faecal sludge as soil conditioner for farming purposes.

Water Resource Sampling
As part of the sociological survey, information regarding the occurrence, frequency, and timing of waterborne diseases (e.g., cholera and diarrhoea) was captured. The information was supplemented by collected water samples from four boreholes used for drinking water and four river sources within the study area (Figures 2 and 3).

Field Study
A key informant interview and questionnaire based on guided questions was done with 10 community leaders (Chief and his council) and residents in the area. The pre-test was used to refine and enhance validity of the questionnaire. A similar approach to the Sanitation Focus Opportunity Ability and Motivation (SaniFOAM) framework [31] was used. The framework analyzes sanitation behaviors to design effective sanitation programs. In the study, 80 participants representing five percent of all households [30] were selected. The key informants provided general information on the management of waste from pit latrines. The information from the key informants was then fitted into a structured questionnaire survey which was used to probe what the communities do when the pit latrines fill up and whether they would be willing to reuse treated faecal sludge as soil conditioner for farming purposes.

Water Resource Sampling
As part of the sociological survey, information regarding the occurrence, frequency, and timing of waterborne diseases (e.g., cholera and diarrhoea) was captured. The information was supplemented by collected water samples from four boreholes used for drinking water and four river sources within the study area (Figures 2 and 3).  Water samples were collected in clean plastic bottles, immediately stored at a temperature below 4 • C and analyzed within 24 h of collection for E. coli and faecal coliforms bacteria at the Institute for Groundwater Studies (IGS), University of the Free State. The water samples were analyzed using the membrane filtration method [32] and the polymerase chain reaction (PCR) method [33] to identify and verify the presence of bacteria. E. coli and faecal coliforms densities were then taken as the number of positive wells which were presented as colony forming units (CFU/100 mL). Samples were collected during three site visits to accommodate seasonal variations, i.e., before the summer rains and during the onset of the rains (October and December 2019 to February 2020).  Water samples were collected in clean plastic bottles, immediately stored at a temperature below 4 o C and analyzed within 24 hours of collection for E. coli and faecal coliforms bacteria at the Institute for Groundwater Studies (IGS), University of the Free State. The water samples were analyzed using the membrane filtration method [32] and the polymerase chain reaction (PCR) method [33] to identify and verify the presence of bacteria. E. coli and faecal coliforms densities were then taken as the number of positive wells which were presented as colony forming units (CFU / 100 mL). Samples

Data Analysis
The questionnaire descriptive and econometric data was analyzed with Statistical Package for the Social Sciences (SPSS, IBM Inc. version 25, Armonk, NY, USA, 2017). Prior to analysis, all the data was assigned a variable code. Variables with more than two responses were categorized to use a binary binomial logistic regression model approach. The model was used to predict the influence of socio-economic and biophysical factors on how they can affect the community water quality, sludge management, and their likelihood to use sludge in agriculture and adopt biochar uses (commercial or locally produced) in pit latrines sludge treatment. A chi-square test was used to verify the significance of the regression model and confirm if the combination of the explanatory factors explained the existing sanitation and water quality within the community. The list of dependent and predictor variable coding and description used in the binary logistic regression are shown in Table 1. In the study, simple descriptive statistics such as frequency, means, minimum and maximum values, and percentages were also calculated. Significant levels were measured at a 5% probability level.

Qualitative Survey
The descriptive data showed that from the 80 participants in the study, 64% were females and 36% males. In the study, 40% of the participants were between the age of 31 and above 55 years. An average of five people in a household were sharing a pit latrine. Most people had an educational literacy, as 77.5% reached secondary level. Only 2.5% were not educated, while 5% had a higher tertiary qualification. The main source of monthly household income of the participants was government grants as 86.3% of people received an income below ZAR 4 500 (equivalent to 240 USD as per May 2020 forex exchange rate; 1 USD = 18.75 ZAR) per month. Of the total participants, only 27.6% were either self-employed or employed, while 72.4% were unemployed (Tables 2 and 3). Variables were further grouped into two categories; 1st group (i.e., good, dispose, willing, and adapting) and 2nd group (i.e., poor, reconstruct new latrine, not willing, and not adapting). Overall, most people (58.8%) stated that the water source they relied on had a good quality as contrasted to 41.3% (poor quality). In the community, 83.3% disposed of their filled pit latrines sludge using the local municipality. The other 16.7% of the people resorted to closing the filled latrine and reconstructing a new latrine using a private contractor or own labor. Most participants below the age of 30 as compared to those older than 30 years were reluctant to use human treated sludge for agricultural purposes. However, overall participants in the study were willing to use treated faecal sludge (60%) in agriculture, as well as adapting biochar use (73.8%) to reduce pit latrine baseline contaminate leaching ( Table 2). The main drinking water source of the participants was obtained from municipality tanks (61%) and boreholes (17.8%). Other household uses relied mainly on the river and rain harvested water. Only a few participants (4.2%) had occasional piped tap water (Table 4). Despite having as many as five water sources, respondents indicated that they could not entirely rely on the constant supply or availability of water. Only two options were identified as a way of dealing with latrines when they filled up. In the community, the municipality (51%) was responsible for sludge disposal and the remaining 49% used private contractors. None of the respondents had the capacity to empty the latrines. Majority of the participants in the study lacked access to any sludge disposal safety equipment (98%). The main sanitation-related disease outbreak was diarrhoea (69%) and cholera (14%). The outstanding 17% of the participants had no knowledge of any disease outbreaks within the community. The study indicated that 91% of the participants planted crops while the other 9% were not involved in any agricultural practice. Of the 91% of participants, 55.5% only planted vegetables (e.g., spinach, beetroot, potatoes, cabbage, and carrots) while the additional 44.5% also had field crops (e.g., maize, beans, and pumpkins). Most of the participants (71%) had knowledge of the use of treated human sludge under agriculture. Majority of the households (83%) were willing to purchase and use biochar for sanitation and agricultural purposes. Nonetheless, only a few participants (8%) were using wood ash to reduce potential pit latrine leaching as contrasted to 92%. Most of the participants (88%) were not aware of the potential leaching from pit latrines as compared to the remaining 12%. Only 23% of the participants were using commercial detergents to treat pit latrine sludge as contrasted to 77%. Of the 23% using detergent, most people (13%) were spending less than ZAR 50 (3 USD) per month and between ZAR 51 to 100 (7%). Only 3% of the participants were willing to spend more ZAR 100 (6 USD) per month on detergent.

Extent of Water, Sanitation Quality, and Sludge Management in the Sampled Monontsha Village
The overall results obtained from the binary logistic regression model indicated that the tested predictor variables (socio-economic and biophysical factors) significantly described the water quality (p < 0.01), faecal sludge management (p < 0.04), sludge application in agriculture (p < 0.05), and biochar adaption (p < 0.05) in the community ( Table 5). Most of the socio-economic and explanatory predictors increased the likelihood ratio of the community to adapt to new technologies (i.e., sludge and biochar) to improve their water quality, as shown with positive β values. Nonetheless, of these factors, only drinking water source and ability to purchase biochar had a significant (p < 0.05) influence on the water quality. Faecal sludge management was highly significant at p < 0.001 of these factors: the drinking water source and detergent price. There was a significant effect at p < 0.05 influenced by sludge draining, access to safety equipment, disease type, crop type, and latrine sludge treatment. Application of sludge in agricultural practices was significantly (p < 0.05) influenced by the sludge filling rate, sludge draining, type of crop, wood ash uses, and latrine detergent price. Biochar adaption was positively and significantly (p < 0.05) affected by the human awareness on sludge use, willingness to purchase biochar, and awareness on the potential groundwater contamination from pit latrines. β is the model intercept coefficient which is the expected mean value of Y when all predictor variables Xn = 0; Exp (β) is odds ratio which represents the constant effect of a predictor X, on the likelihood that one outcome will occur; * and *** Significance at 0.05 and 0.001 probability level; 1 X is the baseline variable for categorical variables in the models.

Bacteria Water Analysis
In general, all the river sources (Table 6) in the study had high bacteria counts (>1 CFU/100 mL). The highest detections for both faecal coliforms and E. coli bacteria were seen in the river water sources above 1 CFU/100 mL. Extreme counts above 2420 CFU/100 mL in the three sampling periods were recorded in site QM 6 which is the main river draining out of the study catchment (Figure 2). In December 2019, site QM 8 was the only drinking source (Borehole) with counted above the minimum recommended threshold (<1 CFU/100 mL), recording 3 CFU/100 mL (Faecal coliforms) and 2 CFU/100 mL (E. coli) ( Table 6). In!the successive sampling phase in February 2020, study site QM 3 (Borehole) showed evidence of faecal coliforms with a count of 1 CFU/100 mL ( Table 6).

Water and Sanitation Qualitative Survey
Decision making is frequently the result of a long process in which numerous steps are essential [35]. Barnard et al. [36] and Tadesse-Yimam et al. [37], in a rural study in northern Ethiopia, suggested that there was no guarantee in the use of methods due to behavioral changes that are required which also rely on cultural norms. A study in rural Niger revealed that mostly male heads of a household make latrine operation and maintenance decisions [17]. In this study, however, in most houses (64%) women were usually responsible for household duties and latrine decisions. Maintenance of such latrines relied solely on the contribution of women. Sometimes the role of women or wives may be more informal even though they largely contribute to latrine decision making [17]. The nature of those involved directly or indirectly in the decision are related to access, use, and willingness to pay in latrine operation and maintenance [35]. Ownership of improved latrines has been strongly related to the socio-economic conditions, spatial distribution, and education status of the household head [38]. A higher education status (97.5%) of the community was shown in the health awareness to use either a VIP/UN-IP latrine. Even though other participants (2.5%) were not educated, the absence of open defecation indicated that a society can be influenced with the community norms. The Swiss TPH [38] report also confirmed that accessibility to improved latrines depends on household income and government subsidies. The survey results they obtained showed that worse-off and intermediate groups only rely on either UN-IP/VIP latrines. Similar observations were noted in this survey study. Qualitative surveys from Bangladesh, Senegal, and India showed that a higher water quality supply is directly linked to improved latrines and improved socio-economic conditions [38,39]. Similar observations were also made from this study survey data as the majority of respondents both had a considerable access to improved water and improved latrines. Swiss TPH [38] noted that in the absence of government subsidies, low income households tend to use unimproved latrines.
Qualitative survey data in Senegal and India indicated that latrine emptying and disposal is not common in rural areas [38]. Similar findings were also seen in the qualitative survey, as some of the participants opted to reconstruct new latrines. Studies in South Africa showed that draining and disposal of each pit latrine costs between ZAR 300 (16 USD) to ZAR 1250 (67 USD) [9,10]. Most of the participants in the survey had a low monthly income which makes it unrealistic in some cases to afford the cost of draining and disposal. Nonetheless, in the context of South Africa, the qualitative survey data also showed that government support through municipality can promote pit emptying. However, Mjoli [40] and Tissington [15], also working in South Africa, argued that most municipalities lack budgets and funds for latrine emptying. In most cases, rural villages in developing countries have a low capacity to pay for latrines [41]. This might have been another reason why most of the respondents (77.5%) in the study were not eager to spend much on pit sludge treatment (Table 4). Swiss TPH [38] reported similar findings as they confirmed 18.6% as compared to a total of 19.6% relying on simple VIP latrines in their study were not able to pay anything towards latrines. In another study, Barnard et al. [36] aligned the constraints to cost of latrines (59.3%) and inadequate savings (34.1%). Moreover, they confirmed in a focus group that a weak capacity to pay exists, as 24.3% of the respondents did not consider latrine disposal and renovation a priority. Jenkins and Scott [37] studied the barriers to latrines access in Ghana and found that high costs and competing priorities were among the main constraints. In this study, commercial detergents or any other pit latrine sludge treatment material were also viewed as a competing priority with 78% of the respondents.
An average of five people in each household filled a latrine in five years as indicated by the qualitative survey. Similar findings in SA were reported by Still and Foxon [9], Brouckaert et al [10], Department of Water Affairs and Forestry (DWAF) [42], and Seal et al [43]. In large households, members tend to be less satisfied with latrine uses [38,44]. In Tanzania, Sara and Graham [41] observed that 40% as contrasted to 50% of households with access to improved latrines barely used them. However, in this study all the respondents relied and used the available latrines. Tadesse-Yimam et al. [37] in northern Ethiopia found out that households with clean latrines were 4.3 times likely to use them. A study in East Java showed that 82.4% of households with private and clean latrines were more satisfied as contrasted to 68.3% with shared latrines [45]. This might also have been another reason people used their household latrines. Moreover, all the latrines were private to each specific household despite sharing with family members. Some of the major factors for use included dangers of feces for health (9%) and maintaining a clean environment (27.5%) [45,46]. In this survey, sanitation diseases (i.e., diarrhoea and cholera) occurred in the community according to the participants. Barnard et al. [36] also confirmed in a survey that 66% of respondents argued that there was a relationship between the utilization of latrines and better health. Findings from Ngondi [46] emphasized that there are advantages in proper latrine uses and sludge treatment practices like fly reduction (41.1%) and disease prevention (35%). Another study in the Ngohe municipality, Kenya observed that the population was keen to adapt a new behavior following awareness of the links between diarrhoea and latrines [1,47]. A cholera epidemic in the area led to an increased demand in improved latrines and better sludge disposal. Other researches in rural Tanzania [48] and in Ethiopia [49] showed that awareness in hygiene and sanitation had a nine-and two-times more likelihood, respectively, in water improvements, improved latrines, and sludge management practices.
Sustainable methods such as biochar have been proved to be successful in sanitation and soil amendment purposes. Williams [50] had positive outcomes with an increased ammonia-nitrogen, P retention and reduction in leaching of faecal coliforms, and E. coli from municipal sludge treated with biochar. Studies have suggested that population growth is directly correlated to waste management [51].
In our survey, most of the participants understood the crop nutritional benefits with the combination of sludge and biochar. Awareness is important for the implementation of sustainable techniques. Studies in SA, eThekwini, Durban have seen projects involving latrine sludge treatment and by-products beneficial in cropping uses, including root crops [13]. A faecal sludge burial study in Umlazi, Durban also showed increased tree growth because of improved nutrient retention and also reduced pathogenic migrations [9]. A social survey study in Ntuzuma and Inada village Kwa-Zulu Natal (KZN) in SA to explore the perception and knowledge of farmers in the use of urine and faecal sludge showed that barriers still exist in usage. Moreover, the capacity of sludge and knowledge of the nutritional benefits is still limited. Negative perceptions due to ethical norms remain, even though farmers have the willingness to adapt [52].

Water Analysis
Detection of pathogenic bacteria within drinking water sources causes a huge threat to human well-being [53][54][55][56][57]. The consequent movement of pathogens with subsurface drainage water to surface water systems has been recognized as a main pathogen transport pathway [53,56]. However, the DWAF [4] groundwater strategy report in SA highlights that groundwater is mostly safe for drinking processes without treatment. The report argues that pathogenic bacteria usually has a short survival rate in aquifers. Such findings can also explain the lower detections of bacteria in most boreholes sampled in the study. Nonetheless, results from column and field research showed that the movement of bacteria through undisturbed soils is mostly governed by macropore flow occurrences [53]. In a case where there is a shared use of VIP/UN-IP latrines as in this study, bacteria leaching can be a problem [3,55]. Physical water filtration is recognized as the principal process which restricts bacteria transport in soil [53,57]. The argument was based on the findings that bacteria range in size from 0.2-5 µm which causes soil straining and adsorption [53,58]. Looking at the results in an E. coli outbreak study in Canada, O'Connor [59] attributed the survival and movement of faecal bacteria to moisture and soil type, among other several factors. Such findings were similar to this study, as it shows that some of the boreholes and rivers counts increased in response to the rainfall season. Groundwater fluctuations had an effect in the population of both E. coli and faecal coliforms. Prevalent detections of faecal bacteria, especially in surface sources such as rivers, have been studied numerously. Niemi and Niemi [60] in Southern Finland observed counts exceeding 100 CFU/per 100 mL in surface water from non-agricultural areas and watersheds. A study in the United States in two catchments detected counts more than 200 CFU/100 mL from streams, wells, and springs [61]. Similar to this study, their results emphasized that streams exceeded the recommended threshold standards with a range between 87% and 100%. Wildi et al. [62] and Pote et al. [63] attributed the contamination of most Swiss rivers and reservoirs to mainly faecal sludge and rainwater drainage.

Implications
Water quality, especially drinking sources, depends on several indicators among faecal bacteria. Water use guidelines and monitoring analysis with the varying seasonal changes is critical. Characterizing a water source based on its appearance and taste only and using these as a quality indicator can be a challenge. In this study, some of the water sources had bacteria indicators above the recommended threshold (>1 CFU/100 mL) ( Table 6). According to the sensorial appearance, the respondents classified the source as a good quality due to their available resources and capacity. Verification of water quality is important and should be aligned to the socio-economic factors to improve the application of the results. In cases where an essential source which people rely on such as rivers are highly contaminated, health awareness to the users is important. This can ensure implementation of treatment improvements prior to use of that particular water source.
Sentiments around the use of faecal sludge as manure are characterized by the lack of education around benefits. The human condition can be defined by negative perceptions of faecal waste as "useless, unnecessary and therefore undesirable" [64]. For this reason, an individual needs training to raise their awareness and thus change this perception. The obvious question mostly arises around the undesirable faecal malodor. As mentioned before, within a community one would need to be able to address the diverse demographics appropriately, the old and uneducated, the young and uneducated, as well as the educated few in a bid to alter their perceptions and encourage the use of faecal sludge. On the other hand, it would be way easier to convince any member of any community about the need to use biochar than faecal waste alone. Use of biochar and sludge together can improve water quality and sanitation, and hence can be a vital focus to motivate communities.
In terms of creating awareness about biochar, the community members can also be made aware that the benefits of using biochar outweigh the potential risks. This is because biochar remains stable with a high adsorption potential of contaminates [27,65,66]. Reduction in sanitation diseases can become preventive rather than having to pay medical bills when there is a diarrhoea or cholera outbreak, which in most cases is recurring if the underlying causes are not resolved or addressed.

Policy Implications
In South Africa, policies such as the National Environmental Management Waste Act [11] and the Strategic Framework for Water Services [6] have been adapted in pit latrines. These policies state the requirements for safe sludge removal/handling in pit latrines. However, such policies are mostly focused on latrine constructions and siting with less attention on sludge management. In terms of most developing countries such as SA, it is beneficial to also include the cost of sludge management. Sludge treatment practices which increases the life span of latrines can also reduce management and disposal costs. Introduction of community programs to repurpose pit latrine sludge to acceptable commercial uses can improve people's living standards.

Conclusions
Water and sanitation lags still exist in South Africa among low income households similar to the study community in Monontsha village. Most people relied on municipal tanks and borehole water sources. Bridging the gap in provision of VIP latrines to the lacking population depending on UN-IP latrines can reduce sanitation-related diseases [8,48,55], i.e., diarrhoea or cholera. In the study, emptying of pit sludge through municipality services was the common management practice. Participants were keen to use biochar amendment in pit latrine sludge treatments. Use of qualitative surveys and analytical data to monitor and determine water quality for drinking water can give a preliminary view on the sources. The supplementary bacteria data indicated a potential contamination in some water sources. Most drinking water sources in the study had detections below the recommended threshold (<1 CFU/100 mL). Bacteria contaminates above 1 CFU/100 mL were observed due to groundwater fluctuations. Extreme E. coli and faecal coliforms counts (>100 CFU/100 mL) were observed in all river sources. Full implementation of a new technology still has setbacks because of dynamics in cultural norms within this society. Awareness can go a long way to motivate individuals to adopt to a new change. In the case of biochar use in water and sanitation and sludge treatment for agricultural purposes, most people were willing to use it after discussions of the potential benefits. Most respondents had knowledge on the use of treated faecal sludge but none of them actually used it before in any agricultural purpose. Future research should focus on application of the sludge perceptive to adapt sustainable uses and also capture more social norms on a larger scale.