Search Results (56)

This study aimed to apply the integrated WASH assessment tool and assess the performance of WASH services in three Internally Displaced Person (IDP) camps in Rakhine State, Myanmar. The tool was applied in a unique non-household setting that is vulnerable to annual storms and storm-induced flooding, while also facing the complexity of political and social constraints. The assessment focused on nine components of the tool: water, sanitation, hygiene, financial, institutional, environmental impacts, technical, social, and climate change. Afterwards, the overall WASH services performance of the three IDP camps was determined. The assessment revealed good performance in water, financial, institutional, and social components across all camps. However, environmental impact, technical, and climate change components showed the need for improvement due to recurrent climate hazards, and their impacts on WASH facilities, such as latrine destruction, saltwater intrusion into handpumps, and increased diarrhea cases. Based on the findings, the study recommends constructing disaster-resilient latrines, reinforcing handpumps with watertight materials, elevating wellheads to prevent contamination, and forming emergency response teams with appropriate training. Overall, Ohn Taw Gyi (South) and Kaung Doke Khar (2) camps had a good level of WASH performance with a 6.38 sum of net scores of components (SAS), and with 6.06 SAS, respectively. Thet Kae Pyin camp had a moderate level of performance with 5.35 SAS. The application of the assessment tool provided valuable data to support evidence-based decision-making. It serves as a useful resource for WASH professionals, humanitarian organizations, and local governments to evaluate service performance and ensure sustainable service provision in their areas. Full article

Pit latrines—the simplest on-site sanitation system—have been extensively used in developing countries in Asia for a long time. However, pit latrines are pollution and health risk hotspots that can cause widespread contamination. It is preferable to upgrade them to septic tanks, which are more advanced, effective, and simple alternatives. This study encourages the transition from pit latrines to septic tanks by making people aware of the health and environmental risks associated with the use of pit latrines. As decisions about sanitation technologies are mostly made by individual households, it is important to find communication tools for the average household to understand the basic information to make informed decisions. To this end, this study used augmented reality as a communication tool. A survey was conducted with Sri Lankan households that use pit latrines, and experiments were carried out in a university laboratory in Japan. The use of augmented reality increased people’s understanding of the environmental and health risks of pit latrines. This understanding was retained for some time because people found the use of augmented reality ‘enjoyable’. Hence, our findings contribute to the promotion of the transition from pit latrines to septic tanks in low- and middle-income countries. Full article

Increased food production and consumption patterns have resulted in higher urban food phosphorus footprints, leading to a series of resource and environmental problems worldwide. We quantified the food phosphorus footprint of the African city of Kisumu using substance flow analysis. Our aim was to develop Kisumu’s sustainable phosphorus management framework so that the city would reduce phosphorus losses into the food system. Our results show that in the year 2023, the import and export of food phosphorus in the Kisumu food system was 2730.26 ± 2.7% t P yr⁻¹ and 3297.05 ± 2.4% t P yr⁻¹, respectively. There was −566.79 ± −18% t P yr⁻¹ food phosphorus deficit in the Kisumu food system. Crop planting subsystem runoff/leaching/erosion loss, household consumption subsystem waste loss, and pit latrine subsystem blackwater loss are the major pathways of phosphorus losses into the environment and the main contributors to the food phosphorus footprint in the city. The 2030 scenario analysis shows that implementing a comprehensive scenario scheme throughout the entire lifecycle process from phosphorus input to waste disposal is the best choice for reducing phosphorus losses and suppressing the growth of food phosphorus footprint in the future. Our study shows that the food phosphorus footprint in the Kisumu food system was 0.67 kg P cap⁻¹yr⁻¹ in 2023, which is still at a low level but may enter a continuous upward trend with the improvement of socio-economic development of the city. In our framework, we have proposed a few essential measures that include urine separation, installation of septic tank, adjustment of dietary structure, flexible layout of sanitary disposal facilities, and separation of organic waste streams to reduce food phosphorus footprints in Kisumu. Given the similarity of cities along the shores of Lake Victoria, our calculation methods and management strategies can be applied to other cities in the region. Full article

Background: Taeniosis and cysticercosis are human infections caused by the pork tapeworm, Taenia solium. This study is a baseline for community-based intervention. We determined the prevalence of human cysticercosis and associated risk factors following a deworming program conducted throughout the country, with Mbulu District being among the districts in Northern Tanzania. Methods: Human cysticercosis was determined by enzyme-linked immunosorbent assay (Ag- ELISA). Household interviews and observations were conducted to identify risk factors for cysticercosis transmissions among households and communities. Results: Three hundred individuals participated in this study. The age ranged from 5 to 89 years, with a median of 19 years. The prevalence of human cysticercosis was 23 (7.67%). The prevalence was high with 6 (11.76%) among individuals aged 26 to 35 years and ±45 years. There was no statistically significant difference in the prevalence by age group, sex, or occupation. Among the 300 participants, 82 (27.3%) had received anthelmintics during the previous year; among these, 5 (21.7%) were infected. The likelihood of infection was low among anthelmintic users by 28% [0.72 (0.26–2.01)], but the protection was not significant. The communities differed in risk factors on the availability of a clean and safe water supply; 52.7% (46/86) of households visited had no pit latrine. The cysticercosis prevalence showed a significant difference in communities. Conclusions: The prevalence of human cysticercosis was high and associated with higher age groups. The prevalence was low among those who had taken anthelmintics and was associated with lower age groups. The current school deworming program has a positive effect on school children, while the elderly are at higher risk because the intervention did not target them. It is recommended to scale up anthelmintic intervention to higher age groups. Full article

The mental health crisis poses a major challenge to global sustainable development. In response, the United Nations has launched an ambitious plan to “reshape the environment that affects mental health”. Clean toilets are an important measure of civilization, yet it is unclear whether they are helping to alleviate the global mental health crisis. Therefore, using data from a large sample of rural Chinese households and introducing an instrumental variables approach based on the IV-Tobit model to address endogeneity, this study quantitatively discusses that clean latrines have a positive effect on the mental health of farm households. The results showed the following: (1) 89.8% of Chinese rural households had clean toilets, while the average farm household depression index was 12.568; and (2) clean toilets helped to improve the mental health of farmers, which means that the depression index of farmers with clean toilets decreased by 66.9% compared to farmers without clean toilets. The findings of this study can inform the development of policies to mitigate the global mental health crisis and contribute to the resilience of global development. Full article

Safely managed sanitation is indispensable for societies to ensure public health, environmental protection, and economic and social development. This could be achieved, in large areas of the world, through dry sanitation systems. Dry sanitation systems are especially used in water-scarce regions and low-income households. In dense peri-urban areas, the achievement of safe sanitation necessitates a comprehensive fecal sludge management (FSM) service chain, surpassing the mere provision of latrines. This research introduces an automatic Multi-Criteria Decision Analysis (MCDA) approach, which focuses on the particular interface/storage stage of the FSM service chain. The tool aims to support the decision-making process and may be especially useful in the early stages of sanitation planning as it compares different technologies with potential application in low-income countries. It includes different criteria and parameters for the Social, Economic, Technical, and Environmental dimensions of dry sanitation options (SETEds), being adaptable to different contexts and to different priorities. The main key strengths of the tool were found to be its minimal data requirements and ability to customize operation and maintenance cost parameters. These features are particularly relevant in data-scarce contexts, where traditional models may lead to unreliable recommendations or lack of solution ownership by users. The tool was applied to the Ambriz case study, a coastal town in Northern Angola, in West Africa. The obtained results are analyzed and show the tool’s application provides technology recommendations aligned with the site and community characteristics. Full article

In African cities, the ever-increasing production of wastewater and excreta poses a major management problem. The aim of this study was to take stock of wastewater and excreta management in Adétikopé in the commune of Agoè-Nyivé 6. This was a cross-sectional, descriptive study of the knowledge, attitudes and practices of the population of the locality of Adétikopé in terms of wastewater and excreta management, which took place from August 2022 to July 2023. It involved 5256 households in 12 villages in the locality of Adétikopé and was carried out via a field survey, interviews, observations and documentary research. The results showed that 72.60% of respondents were women. The majority of households (85.62%) had latrines, 66.40% of which had never been emptied. The remainder used a mechanical emptying truck (5.48%). Households without latrines (14.38%) defecate with neighbors (14.28%) in the open (66.67%) and in public latrines (19.05%). The same applies to wastewater from cooking, washing and dishwashing, which is most often dumped on the public highway (78.77%). Wastewater is a breeding ground for mosquitoes that cause malaria, which is the most common disease in the area. The results of this study show that wastewater and excreta are managed by most concessions in an unhealthy way and discharged into the environment. It is important to step up public awareness campaigns on the harmful consequences of poor wastewater and excreta disposal. Full article

Community-led total sanitation (CLTS) is a widely used approach for enhancing sanitation practices. However, the impact of boosted CLTS on household latrine ownership has not been adequately evaluated. This study aims to investigate the factors associated with latrine possession among households, with a specific focus on single and CLTS-boosting implementation. A community-based repeated cross-sectional study was conducted in Siaya County, Kenya, involving 512 households at the baseline and 423 households at the follow-up. Data were analyzed using the mixed-effects logistic regression model. At the baseline, latrine possession was significantly associated with CLTS implementation (adjusted OR [aOR]: 3.01; 95% confidence interval [CI]: 1.41–6.44), literacy among households (aOR: 1.83; 95% CI: 1.12–2.98) and higher socioeconomic status (SES) (second level: aOR: 2.48; 95% CI:1.41–4.36, third level: aOR: 3.11; 95% CI: 1.76–5.50, fourth level: aOR: 10.20; 95% CI: 5.07–20.54). At follow-up, CLTS boosting (aOR: 7.92; 95% CI: 1.77–35.45) and a higher SES were associated with increased latrine ownership (second level: aOR: 2.04; 95% CI: 0.97–4.26, third level: aOR: 7.73; 95% CI: 2.98–20.03, fourth level: aOR: 9.93; 95% CI: 3.14–28.35). These findings highlight the significant role played by both single and CLST boosting in promoting universal latrine ownership and empowering vulnerable households to understand the importance of sanitation and open defecation-free practices. Full article

Objectives: This study aimed to estimate the prevalence of Giardia lamblia infection and identify associated risk factors at both individual and community levels in a pediatric population in different agroecological zones of Khyber Pakhtunkhwa, Pakistan. Methods: A community-based cross-sectional study was conducted from March to December 2022. Using stratified sampling, 1026 households were recruited from nine agroecological zones. Stool samples were collected from 1026 children up to the age of five years and processed for detection of Giardia using a commercial ELISA kit. Data on potential risk factors were collected using a pre-structured questionnaire. A multivariable logistic regression model was used to identify risk factors associated with giardiasis. Results: The study found that the prevalence of giardiasis in the study area was 3.31%. Children aged 13–24 months were found to be at higher risk for giardiasis. Illiterate mothers and fathers attending daycare institutions/kindergartens, mothers not practicing hand washing during critical times, households with companion animals, and homes where stray dogs/cats enter were identified as predictors of giardiasis at the individual level. Children living in sub-mountain valleys use un-piped water, inadequate domestic water storage vessels, drink un-boiled or unfiltered water, live near rubbish heaps or un-paved streets/pathways, and have unimproved latrine facilities were identified as risk factors of giardiasis at the community level. Conclusions: The study highlights the need for integrated intervention approaches at both individual and community levels to reduce the incidence of giardiasis in Khyber Pakhtunkhwa, Pakistan. Interventions aimed at promoting behavioral change and providing safe and adequate water sources, combined with individual-level interventions such as hand washing and awareness of giardiasis prevention methods, would be critical to addressing this health concern. Inter-sectoral collaboration between the health sector and other sectors would also be necessary to achieve meaningful progress in reducing the incidence of giardiasis in resource-limited areas. Full article

The water sanitation and hygiene (WASH) sector has provided beneficiaries in low and middle-income countries with latrines and clean water for decades. However, we still need good evidence documenting the expected health impact. This paper investigates why we lack this evidence and ways to move forward. Using mTEC agar, we monitored E. coli contamination on selected “hotspot” surfaces within the kitchen environments of 32 low-income households in Dhaka, Bangladesh, every six weeks for two years. Despite being washed, the highest average contamination was found on food plates, at 253 cfu/10 cm², followed by cutting knives, with 240 cfu/10 cm². The drinking vessel surfaces and the latrine doorknobs had the lowest contaminations, with E. coli means of 167 and 73 cfu/10 cm², respectively. These findings imply a need to measure an individual’s pathogen exposure as close to the mouth as possible to estimate the true pathogen exposure. The paper proposes introducing the new “personal domain”—the point of consumption—as the physical sphere in which WASH interventions should be assessed. With this approach, we can observe and quantify the different pathogen exposure routes and, with this, further improve WASH interventions. Full article

Schistosomiasis prevalence has remained high in some areas due to reinfection despite repeated mass drug administration interventions. We aimed to explore its risk factors in order to help to design adequate interventions in such high-transmission areas. A total of 6225 individuals residing in 60 villages in 8 districts of North Kordofan, Blue Nile, or Sennar States, Sudan participated in the community-based survey in March 2018. First, we investigated Schistosoma haematobium and Schistosoma mansoni prevalences among school-aged children and adults. Second, the associations between risk factors and schistosomiasis were explored. Those without any type of latrine in their households had higher odds of being infected with schistosomiasis than those with a latrine (odds ratio (OR) = 1.53; 95% confidence interval (CI) 1.20–1.94; p = 0.001), and the odds of being positive for schistosomiasis among people living in a household without an improved latrine were higher than for their counterparts with an improved latrine (OR = 1.63; CI 1.05–2.55; p = 0.03). Furthermore, people with households or outside compounds found to contain human faeces had higher odds of being infected with schistosomiasis than their counterparts (OR = 1.36, 95% CI 1.01–1.83, p = 0.04). Installing an improved latrine and eliminating open defecation should be highlighted in schistosomiasis elimination projects in high-transmission areas. Full article

Good access and appropriate use of Water, Sanitation and Hygiene (WASH) is important in the control, elimination and eradication of a number of neglected tropical diseases (NTDs). Poor WASH access and use may explain continued high trachoma prevalence in Nabilatuk district, Uganda. This study aimed to investigate the level of WASH access and use through different WASH data collection methods and the triangulation of their results. A mixed-methods cross-sectional study was conducted in 30 households in Nabilatuk district, from 10 households in each of three nomadic villages. The data collection methods used were: (1) direct observations of routine WASH behaviours; (2) structured quantitative household questionnaires; (3) demonstrations of specific WASH behaviours. With regards to access, observations indicated less WASH access and use compared with questionnaire responses: the questionnaire indicated all households had access to an improved water source, but 70% had a >30-min round-trip, and no households had access to an improved latrine, whereas some observations indicated longer water collection times. In terms of behaviour, there were also differences between the data collection methods, with demonstrations revealing knowledge of good practice, such as thorough handwashing, but this was not routinely observed in the observations. Further systematic investigation of barriers to appropriate WASH access and use in the local context is needed, as is the development of feasible, valid and reliable WASH access and use assessment methods for use in national NTD programmes. Full article

Pharmaceuticals are widely used in Africa due to the high burden of human and animal diseases. However, a review of the current practices and pollution risks arising from the disposal of pharmaceuticals in low-income settings in Africa is still lacking. Therefore, the present review examined the literature to address the following questions: (1) what are the key factors driving the accumulation of unused and expired pharmaceuticals?, (2) what are the current disposal practices for unused and expired pharmaceuticals, and wastewater (feces and urine) containing excreted pharmaceuticals?, (3) what are the potential environmental and human health hazards posed by current disposal practices?, and (4) what are the key research needs on the disposal of pharmaceuticals in low-income settings? Evidence shows that, in low-income settings, wastewater comprising predominantly of feces and urine containing excreted pharmaceuticals often end up in on-site sanitation systems such as pit latrines, septic tanks, and the environment in the case of open defecation. Unused and expired pharmaceuticals are disposed of in pit latrines, household solid waste, and/or burned. The pollution risks of current disposal practices are poorly understood, but pharmaceutical pollution of groundwater sources, including those used for drinking water supply, may occur via strong hydrological connectivity between pit latrines and groundwater systems. Potential high-risk pollution and human exposure hotspots are discussed. However, compared to other environmental compartments, the occurrence, dissemination, fate, and human health risks of pharmaceuticals in the pit latrine-groundwater continuum are still understudied. Future research directions are discussed to address these gaps using the Source-Pathway-Receptor-Impact-Mitigation (SPRIM) continuum as an organizing framework. Full article

Digital health is considered an opportunity to engage a wider community in disease control for public health. It has been used in healthcare consultation, in medical treatments and in reporting emergencies. The current study developed digital health literacy content for public health education and assessed its effects on porcine cysticercosis prevalence, pig-keeping style and pig pen and latrine qualities. The intervention was designed and evaluated on the prevention and control of porcine cysticercosis in the Iringa District of southern Tanzania. A quasi-controlled field trial with pre-intervention and post-intervention assessments of porcine cysticercosis, pig-keeping style and pig pen and latrine qualities was conducted. A baseline cross-sectional study was followed immediately by digital health literacy intervention, which comprised educational messages on porcine cysticercosis shown on computer tablets or smartphones. Free internet access supported unsupervised community access. The 25-month post-intervention assessments revealed significantly increased pig confinement (20.1%) (p = 0.026) and pig pen quality (16.2%) (p = 0.025). However, the quality of household latrines (p = 0.453) was not improved, nor was there any significant effect on the prevalence of porcine cysticercosis (p = 0.231). The digital health literacy intervention suggests a strategy for wider and sustainable dissemination of educational messages for Taenia solium infection control. Full article

The use and abuse of antibiotics are directly related to the development of drug resistance, a global public health problem. Whereas the majority of research focus is on the use and misuse of antibiotics in drug resistance development, little is known about improper disposal, as a source of contamination in the environment that includes groundwater, especially in informal settlements. This study sought to determine antibiotic use and disposal in informal settlements in Kisumu, Kenya. A random cross-sectional sample of 447 households in selected informal settlements of Kisumu, Kenya was studied. A structured questionnaire was issued to persons heading households. The prevalence of antibiotic use was 43% (n = 193). Among these people, 74% (n = 144) had consulted a health worker in a healthcare facility for a prescription. Respondents did not always complete doses but kept the remainder for the next time they would become ill (54%). About 32% disposed of the remainder of the antibiotics in pit latrines and compost pits (10%) while 4% disposed through burning. Antibiotic use was fairly high despite a low level of awareness of the health effects of consuming water contaminated with antibiotics (35%) (n = 156); p = 0.03. Misuse and inappropriate disposal of antibiotics as identified may lead to a higher risk of antibiotic resistance, increasing the disease burden in the informal settlements. Full article