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Aydamo AA, Robele Gari S, Mereta ST. Seasonal Variations in Household Water Use, Microbiological Water Quality, and Challenges to the Provision of Adequate Drinking Water: A Case of Peri-urban and Informal Settlements of Hosanna Town, Southern Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241238940. [PMID: 38525297 PMCID: PMC10958793 DOI: 10.1177/11786302241238940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
Several studies have been conducted on household water use and microbial water quality globally. However, studies that considered seasonal variability of household water use and microbial water quality were limited. Therefore, this study investigated the seasonal variability of household water use, microbiological water quality, and challenges to the provision of adequate water in the peri-urban and informal settlements of Hosanna town, Southern Ethiopia. A longitudinal study was conducted on 288 households. The data was gathered using a pretested structured questionnaire, laboratory-analysis, interviews, storage-container inventories, focus group discussions, key-informant interviews, and an observational checklist. The data was analyzed using stepwise-multiple linear regression, bivariate and multivariable logistic regression, thematic-analysis, t-tests, and non-parametric-tests. Households were visited for 7 consecutive days during the dry and rainy seasons to account for changes in daily and seasonal variation of water use. 440 stored water and 12 source samples were analyzed for E. coli presence during dry and rainy seasons. The prevalence of stored water contamination with E. coli was 43.2% and 34.5% during the dry and rainy seasons, respectively. The per capita water consumption was 19.4 and 20.3 l during the dry and rainy seasons, respectively. Piped water on-premises, small family size, volume, and number of water storage containers were significant predictors of per capita water consumption in both seasons. Piped water off-premises, storing water for more than 3 days, uncovered, and wide-mouthed water storage containers were significantly associated with the presence of E. coli in water in both seasons. Seasonal variability of household water use and microbiological water quality was statistically significant, which is a significant public health concern and needs intervention to enhance water quantity and quality to mitigate the risk of waterborne diseases. Findings also suggest seasonal monitoring of the safety of drinking water to ensure that the water is safe and healthy.
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Affiliation(s)
- Abiot Abera Aydamo
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Environmental Sciences, Wachemo University, Hosanna, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid Tiku Mereta
- Department of Environmental Health and Technology, Jimma University, Jimma, Ethiopia
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Saxena D, Raheja L, Tamma RR, Jain PK, Takhelchangbam N. Assessment of Safe Drinking Water Handling Practices in Households of Northern India: A Cross-Sectional Study. Cureus 2024; 16:e55888. [PMID: 38595898 PMCID: PMC11003323 DOI: 10.7759/cureus.55888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Background Waterborne diseases are the most common form of infectious disease, spreading from contaminated water, especially in a developed country. These diseases are a major concern for the environment and public health. The living conditions in developing countries like India affect the water-handling practices, which make the population vulnerable to waterborne diseases. The inability to access safe drinking water also adds to this. Water safety for a community relies on water collection, treatment, storage, and handling in the household setting. Therefore, the burden of waterborne disease can be reduced by treating point-of-use drinking water, including improving handling and transport. Objectives The aim was to assess the safe drinking water handling practices in households. The objectives were to assess the safe drinking water-handling practices, namely, treatment, storage, lid status of the storage vessel, and water drawing technique, and to estimate the sources of safe drinking water. Methods This cross-sectional study was conducted in the Etawah district on a total of 312 eldest female family members actively working in the kitchen. Descriptive analysis and Chi-Square test were applied to the collected data and a p-value <0.05 at 95% confidence interval (CI) was taken as statistically significant. Results Overall, 135 (85.9%) households in urban areas relied on public supply. However, in rural areas mostly 130 (83%) households depended on private supply. In water-handling practices, 276 (88.4%) used some method to purify drinking water, a total of 209 (67%) households kept the lid of the storage container covered, and 249 (79.8%) households drew water either by pouring or scooping with a long handle. Conclusion The study concluded that both private and public sources were used for drinking water. Regarding water-handling practices, most households drank purified water, kept their containers covered, and drew water either by scooping or pouring from storage containers. Those who drank purified water mostly belonged to nuclear families and had private sources of drinking water.
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Affiliation(s)
- Deepanshi Saxena
- Epidemiology and Public Health, Sarojini Naidu Medical College, Agra, IND
| | - Lokesh Raheja
- Community Medicine, Amar Shaheed Jodha Singh Attaiya Thakur Dariyao Singh Medical College, Fatehpur, IND
| | - Raja Rao Tamma
- Community Medicine, Umanath Singh Autonomous State Medical College, Jaunpur, IND
| | - Pankaj K Jain
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
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Hsu CC, Shr YHJ. The impacts of water storage infrastructure on real property values and crop production. WATER RESEARCH 2023; 247:120786. [PMID: 37925857 DOI: 10.1016/j.watres.2023.120786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Water storage infrastructure is an indispensable part of many water supply systems, and its importance is experiencing a resurgence due to the increasing water irregularity induced by climate change and ever-growing water demand. Leveraging the commission of Hushan Reservoir in Taiwan as a quasi-experiment, this study provides some of the first causal evidence of the economic benefits of a reservoir from housing market and crop production for guiding sustainable water management. Using the administrative property transaction data and a spatial difference-in-differences framework, we find that the commission of Hushan Reservoir increases the values of residential property and farmlands by 4.1 and 8.9 %, respectively. We also find that enhanced irrigation water availability increases rice yield by over 4 % but has no impact on planted areas. Despite expectations of reduced groundwater use, our results show no evidence of a rebound in groundwater levels in the four years following the commission of the reservoir.
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Affiliation(s)
- Chia-Chen Hsu
- Department of Agricultural Economics, National Taiwan University, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City 10617, Taiwan
| | - Yau-Huo Jimmy Shr
- Department of Agricultural Economics, National Taiwan University, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City 10617, Taiwan.
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Adhikari S, Hunter E, Vossenberg JVD, Thomas J. A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data. Int J Hyg Environ Health 2023; 254:114261. [PMID: 37734133 DOI: 10.1016/j.ijheh.2023.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.
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Affiliation(s)
- Sabita Adhikari
- School of Civil Engineering, The University of Sydney, Australia.
| | - Erin Hunter
- Department of Public Health Sciences, College of Behavioural, Social and Health Sciences, Clemson University, United States.
| | - Jack van de Vossenberg
- Water Supply, Sanitation and Environmental Engineering Department, IHE Delft Institute of Water Education, the Netherlands.
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Holcomb DA, Monteiro V, Capone D, António V, Chiluvane M, Cumbane V, Ismael N, Knee J, Kowalsky E, Lai A, Linden Y, Mataveia E, Nala R, Rao G, Ribeiro J, Cumming O, Viegas E, Brown J. Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention. BMJ Open 2023; 13:e067941. [PMID: 37290945 PMCID: PMC10254709 DOI: 10.1136/bmjopen-2022-067941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. METHODS AND ANALYSIS We are conducting a cross-sectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by human subjects review boards at the Ministry of Health, Republic of Mozambique and the University of North Carolina at Chapel Hill. Deidentified study data will be deposited at https://osf.io/e7pvk/. TRIAL REGISTRATION NUMBER ISRCTN86084138.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa Monteiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Virgílio António
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Márcia Chiluvane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Victória Cumbane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Nália Ismael
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Erin Kowalsky
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Lai
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elly Mataveia
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rassul Nala
- Division of Parasitology, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Gouthami Rao
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jorge Ribeiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Edna Viegas
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Hernández-Vásquez A, Visconti-Lopez FJ, Vargas-Fernández R. Escherichia coli Contamination of Water for Human Consumption and Its Associated Factors in Peru: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 108:187-194. [PMID: 36509044 PMCID: PMC9833058 DOI: 10.4269/ajtmh.22-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
The objective of the study was to determine the factors associated with the presence of Escherichia coli contamination in water supplies for human consumption in Peru. A secondary analysis of the Food and Nutrition Surveillance by Life Stages survey (VIANEV) of 2017-2018 was performed. The presence of E. coli contamination in the water samples for human consumption of the households evaluated was defined as a dependent variable. A supply was considered contaminated when there was at least 1 colony-forming unit of E. coli in 100 mL of water for human consumption. Data from 886 participants were analyzed. It was found that 25.2% of household water supply sources for human consumption had E. coli at the time of sampling. Water reservoirs such as buckets or other containers (adjusted prevalence ratio [aPR]: 1.15; 95% confidence interval [CI]: 1.18-1.93), households belonging to a poor wealth quintile (aPR: 1.82; 95% CI: 1.01-3.25), residing in a rural area (aPR: 1.36; 95% CI: 1.01-1.83), and having a low human development index (aPR: 2.12; 95% CI: 1.15-3.91) were more likely to contain E. coli in water supplies for human consumption. However, households with chlorine concentrations of 0.5 mg/L or more in water (aPR: 0.20; 95% CI: 0.11-0.33) and with household members with a higher education (aPR: 0.67; 95% CI: 0.45-0.99) were less likely to contain E. coli in drinking-water supplies. From 2017 to 2018, one in four Peruvians had contamination by E. coli in the water supply to their homes, which was associated with sociodemographic factors, management, and water treatment.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Achore M, Bisung E. Do perceived inequalities in safe water access manifest in collective action? Evidence from urban Ghana. Health Promot Int 2022; 37:6884542. [PMID: 36482785 DOI: 10.1093/heapro/daac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Access to safe drinking water is critical in improving health and well-being. It is estimated that >40% of urban households in Ghana do not have access to safe drinking water. Although the willingness and ability of community members to collectively take local initiatives are essential to curtailing inequities in water access in Ghana, the determinant of collective action is less explored. This paper explores determinants of collective action in water-insecure neighbourhoods and examines how perceived inequities in access to water and trust mediate the relationship between lack of access to water and collective action in urban Ghana. The results show that the urban poor OR = 12.047 (p = 0.000) were more likely to participate in water-related collective action compared to wealthy individuals. Primary decision-makers were 1.696 times more likely to participate in collective (p = 0.02). We also found that perceived inequities OR = 0.381 (p = 0.00) significantly predict participation in collective action to address water insecurity. Water service providers should be subjected to a rigid state-level framework that ensures inclusivity, fairness and justice in their distribution systems.
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Affiliation(s)
- Meshack Achore
- Department of Kinesiology and Health Sciences, Columbus State University, 4225 University Avenue, Columbus, GA 31907, USA
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University, 26 Division Street, Kingston, ON k7l 2n9, Canada
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Susilawati, Harahap RH, Mulya MB, Andayani LS. Behavior Model of Community-Based Sanitation Management in Coastal Areas: Confirmatory Factor Analysis. Heliyon 2022; 8:e11756. [PMID: 36468088 PMCID: PMC9713344 DOI: 10.1016/j.heliyon.2022.e11756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/20/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background The research aims to analyze the factors consisting of resident status, gender role, stakeholder roles, infrastructure, socio-cultural, and socio-economic that influence the community behavior in managing the sanitation of coastal areas. Methods A cross-sectional design obtained 504,955 households of family heads in the Percut Sei Tuan Sub-district. The sample size was calculated using a category survey formula of 414 households. A simple random sampling technique was used, and the questionnaire instrument was tested for validity and reliability. The data were analyzed using CFA (Confirmatory Factor Analysis) to assess the factors that influence community behavior in managing sanitation. Results There was a socio-cultural relationship with the behavior of managing sanitation in coastal communities with a T-statistic value of 3.268. Furthermore, gender, infrastructure, and stakeholders' roles influence the behavior of managing sanitation with a T-statistic value of 3.310, 3.573, and 2.263, respectively. Conclusions Socio-cultural practices require motivation and support from various parties in creating good sanitation areas. Therefore, support from stakeholders is needed to influence the achievement of certain goals. They have the authority and budget that can be allocated to support efforts and improve sanitation.
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Sanitation, water, energy use, and traffic volume affect environmental quality: Go-for-green developmental policies. PLoS One 2022; 17:e0271017. [PMID: 36026488 PMCID: PMC9417191 DOI: 10.1371/journal.pone.0271017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
Carbon emissions are primarily the result of human activity in urban areas. Inadequate sanitary facilities, contaminated drinking water, nonrenewable energy, and high traffic congestion have all impacted the natural ecosystem. Using data from 1975 to 2019, the study assessed the impact of the aforementioned variables on Pakistan’s carbon emissions in light of this crucial fact. The ARDL cointegration method was used to estimate the short- and long-run parameter estimates. Urban sanitation challenges and energy consumption increase carbon emissions, which affects the natural environment by raising a country’s carbon intensity. Economic expansion confirmed the inverted U-shaped relationship between carbon emissions and economic growth to verify the Environmental Kuznets Curve (EKC) hypothesis in the long run. In contrast, the monotonically rising function of carbon emissions provides evidence of the nation’s economic development in the short run. Access to clean drinking water improves population health and encourages the purchase of eco-friendly products. The government must improve sanitation services and use renewable energy sources to enhance air quality.
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Tetteh JD, Templeton MR, Cavanaugh A, Bixby H, Owusu G, Yidana SM, Moulds S, Robinson B, Baumgartner J, Annim SK, Quartey R, Mintah SE, Bawah AA, Arku RE, Ezzati M, Agyei-Mensah S. Spatial heterogeneity in drinking water sources in the Greater Accra Metropolitan Area (GAMA), Ghana. POPULATION AND ENVIRONMENT 2022; 44:46-76. [PMID: 35974746 PMCID: PMC9371963 DOI: 10.1007/s11111-022-00407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Universal access to safe drinking water is essential to population health and well-being, as recognized in the Sustainable Development Goals (SDG). To develop targeted policies which improve urban access to improved water and ensure equity, there is the need to understand the spatial heterogeneity in drinking water sources and the factors underlying these patterns. Using the Shannon Entropy Index and the Index of Concentration at the Extremes at the enumeration area level, we analyzed census data to examine the spatial heterogeneity in drinking water sources and neighborhood income in the Greater Accra Metropolitan Area (GAMA), the largest urban agglomeration in Ghana. GAMA has been a laboratory for studying urban growth, economic security, and other concomitant socio-environmental and demographic issues in the recent past. The current study adds to this literature by telling a different story about the spatial heterogeneity of GAMA's water landscape at the enumeration area level. The findings of the study reveal considerable geographical heterogeneity and inequality in drinking water sources not evidenced in previous studies. We conclude that heterogeneity is neither good nor bad in GAMA judging by the dominance of both piped water sources and sachet water (machine-sealed 500-ml plastic bag of drinking water). The lessons from this study can be used to inform the planning of appropriate localized solutions targeted at providing piped water sources in neighborhoods lacking these services and to monitor progress in achieving universal access to improved drinking water as recognized in the SDG 6 and improving population health and well-being.
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Affiliation(s)
- Jacob Doku Tetteh
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
| | - Michael R. Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | | | - Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - George Owusu
- Institute of Statistical Social and Economic Research, University of Ghana, Accra, Ghana
| | | | - Simon Moulds
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Brian Robinson
- Department of Geography, McGill University, Montreal, Canada
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | | | | | - Ayaga Agula Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E. Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Majid Ezzati
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
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Wada OZ, Olawade DB, Oladeji EO, Amusa AO, Oloruntoba EO. School water, sanitation, and hygiene inequalities: a bane of sustainable development goal six in Nigeria. CANADIAN JOURNAL OF PUBLIC HEALTH 2022; 113:622-635. [PMID: 35411423 PMCID: PMC8999996 DOI: 10.17269/s41997-022-00633-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Abstract
Objectives
The importance of school water, sanitation, and hygiene (WASH) in achieving the Sustainable Development Goal targets 6.1 and 6.2 in developing countries cannot be overemphasized. However, widespread WASH inequalities remain an impediment to achieving the targets by 2030. Hence, this study was conducted to examine current school-WASH disparities among public and private schools in a low-income Nigerian community using mixed methods.
Methods
The cross-sectional survey utilized multi-stage sampling to select 400 students from five public and five private schools in Akinyele, Ibadan. Semi-structured questionnaires and observational checklists were used to obtain data. Inferential statistics were measured at a 95% confidence interval. Independent variables like the students’ sociodemographic characteristics, school type, and available WASH facilities were associated with dependent variables like respondents’ hand hygiene and sanitation practices and WASH-associated knowledge and attitude to examine existing inequalities.
Results
Classifying the available WASH facilities based on the WHO/UNICEF Joint Monitoring Programme, none of the public schools provided any sanitation and hygiene service, while all the private schools provided both services. Furthermore, the private-school students had significantly better WASH knowledge (p<0.001; Ƞ2p=0.152) and attitude (p<0.001; Ƞ2p=0.036) compared with the public-school students. Also, a significantly higher portion of public-school students practiced open defecation at school (p<0.001; odds ratio (OR)=7.4; confidence interval (CI)=4.1–13.5) and at home (p<0.001; OR=7.8; CI=3.7–16.7).
Conclusion
WASH disparities among socioeconomic groups remain a persistent challenge. Sole reliance on the Government to narrow the inequalities has persistently proven unfruitful. There is a need to empower local community stakeholders to facilitate sustainable school-WASH interventions.
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Affiliation(s)
- Ojima Zechariah Wada
- Division of Sustainable Development, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
| | - David Bamidele Olawade
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Aminat Opeyemi Amusa
- Roseberry Park Hospital, Tees, Esk and Wear Valleys, Middlesbrough, United Kingdom
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Spatial heterogeneity of neighborhood-level water and sanitation access in informal urban settlements: A cross-sectional case study in Beira, Mozambique. PLOS WATER 2022; 1. [PMID: 36258753 PMCID: PMC9573900 DOI: 10.1371/journal.pwat.0000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Rapid urbanization, resulting in population growth within informal settlements, has worsened exclusion and inequality in access to water and sanitation (WASH) services in the poorest and most marginalized communities. In this study, we describe the heterogeneity in water service satisfaction and WASH access in low-income, peri-urban neighborhoods of Beira, Mozambique, and examine whether this heterogeneity can be explained by distance to water distribution mains. Using spatial statistics and regression analyses, we identify spatial heterogeneity in household WASH access, as well as consumer-reported satisfaction with water services (services, pressure, quality, and sufficient quantity). We find that as distance from the water main increased, both access to an improved water source at the household and satisfaction with water pressure decreases, and water supply intermittency increases, controlling for household density and socioeconomic status. The odds of a household having access to a water source at the household or on the compound decreases with every 100-meter increase in distance from a water main pipe (odds ratio [OR] 0.87, 95% confidence interval [CI]: 0.82, 0.92). Satisfaction with water services also decreases with every 100-meter increase in distance from a water main pipe (OR: 0.80; 95% CI: 0.69, 0.94). Days of availability in the past week decreases by a factor of 0.22 for every 100-meter increase in distance from the water main (95% CI: −0.29, −0.15). Findings from this study highlight the unequal household access to water and sanitation in urban informal settlements, even within low-income neighborhoods. Describing this heterogeneity of access to water services, sanitation, and satisfaction—and the factors influencing them—can inform stakeholders and guide the development of infrastructural solutions to reduce water access inequities within urban settings.
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Ballard AM, Cooper HLF, Young AM, Caruso BA. 'You feel how you look': Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use. PLOS WATER 2022; 1:e0000019. [PMID: 38742171 PMCID: PMC11090493 DOI: 10.1371/journal.pwat.0000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Existing literature attests to water, sanitation, and hygiene (WASH) inequities among people experiencing homelessness (PEH) in the United States, but there is a dearth of research on such issues in rural areas. Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.
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Affiliation(s)
- April M. Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, United States of America
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Bethany A. Caruso
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
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Hamel P, Tan L. Blue-Green Infrastructure for Flood and Water Quality Management in Southeast Asia: Evidence and Knowledge Gaps. ENVIRONMENTAL MANAGEMENT 2022; 69:699-718. [PMID: 33860825 PMCID: PMC9012722 DOI: 10.1007/s00267-021-01467-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
In Southeast Asia, projections of rapid urban growth coupled with high water-related risks call for large investments in infrastructure-including in blue-green infrastructure (BGI) such as forests, parks, or vegetated engineered systems. However, most of the knowledge on BGI is produced in the global North, overlooking the diversity of urban contexts globally. Here, we review the literature on BGI for flood risk mitigation and water quality improvement in Southeast Asian cities to understand the scope of practical knowledge and identify research needs. We searched for evidence of local types of BGI in peer-reviewed and grey literature and assessed the performance of BGI based on hydrological, societal, and environmental metrics. The body of literature on BGI in Southeast Asia is small and dominated by wealthier countries but we found evidence of uptake among researchers and practitioners in most countries. Bioretention systems, constructed wetlands, and green cover received the most attention in research. Evidence from modelling and laboratory studies confirmed the potential for BGI to address flooding and water quality issues in the region. However, practical knowledge to mainstream the implementation of BGI remains limited, with insufficient primary hydrological data and information on societal and environmental impacts. In addition, the performance of BGI in combination with grey infrastructure, under climate change, or in informal settlements is poorly studied. Future research and practice should focus on producing and sharing empirical data, ultimately increasing the regional knowledge base to promote efficient BGI strategies.
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Affiliation(s)
- Perrine Hamel
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore.
| | - Leanne Tan
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
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Beard VA, Satterthwaite D, Mitlin D, Du J. Out of sight, out of mind: Understanding the sanitation crisis in global South cities. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 306:114285. [PMID: 35016141 PMCID: PMC8819159 DOI: 10.1016/j.jenvman.2021.114285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 05/28/2023]
Abstract
Global monitoring efforts do not provide a clear picture of the challenge of managing human waste at the city scale. Where cities do not provide universal access to publicly managed sanitation systems, households and communities find their own solutions resulting in a patchwork of approaches to removing human waste from places where people live. In dense urban environments, the absence of a coordinated approach can create serious public health problems. In the absence of comparable city-level data, we analyze primary and secondary data from 15 cities and 15 informal settlements in sub-Saharan Africa, South Asia, and Latin America. Across these regions, our study finds that 62 percent of human waste is not safely managed. We also find that, while many cities have a proportion of households connected to sewers, none of the 15 cities safely manage human waste at scale. In the absence of sewers, on-site fecal sludge management systems place enormous responsibility on households and private providers, and unaffordable sanitation options result in risky sanitation practices.
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Affiliation(s)
| | | | - Diana Mitlin
- University of Manchester, International Institute for Environmental Development, UK
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Social beliefs and women's role in sanitation decision making in Bihar, India: An exploratory mixed method study. PLoS One 2022; 17:e0262643. [PMID: 35085326 PMCID: PMC8794139 DOI: 10.1371/journal.pone.0262643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/01/2022] [Indexed: 11/19/2022] Open
Abstract
In low- and middle-income countries, poor autonomy prevents women from making financial decisions, which may impact their access to improved sanitation facilities. Inadequate access to improved sanitation disproportionately affects women's and children's health and wellbeing. Although socio-cultural factors are known contributors to gender inequity, social beliefs that potentially motivate or dissuade women from making sanitation-related household decisions are not well understood. These beliefs may vary across settlement types. To empower more women to make sanitation-related decisions, the relevant socio-cultural norms and underlying social beliefs need to be addressed. In this mixed methods study, we explored women's role in sanitation-related decision making in three settlement types, urban slums, peri-urban, and rural communities in Bihar. Trained qualitative researchers conducted six focus group discussions with women of two age groups: 18-30 years old, and 45-65 years old to understand the norm-focused factors around women's role in getting a toilet for their household. Using insights generated from these group discussions, we developed and conducted a theory-driven survey in 2528 randomly selected participants, to assess the social beliefs regarding women making toilet construction decisions in these communities. Overall, 45% of the respondents reported making joint decisions to build toilets that involved both men and women household members. More women exclusively led this decision-making process in peri-urban (26%) and rural areas (35%) compared to urban slums (12%). Social beliefs that men commonly led household decisions to build toilets were negatively associated with women's participation in decision making in urban slums (adjusted prevalence ratio, aPR: 0.53, 95% CI: 0.42, 0.68). Qualitative insights highlighted normative expectations to take joint decisions with elders, especially in joint family settings. Surrounding norms that limited women's physical mobility and access to peers undermined their confidence in making large financial decisions involved in toilet construction. Women were more likely to be involved in sanitation decisions in peri-urban and rural contexts. Women's involvement in such decisions was perceived as widely acceptable. This highlights the opportunity to increase women's participation in sanitation decision making, particularly in urban contexts. As more women get involved in decisions to build toilets, highlighting this norm may encourage gender-equitable engagement in sanitation-related decisions in low-resource settings.
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Rhodes-Dicker L, Brown NJ, Currell M. Unpacking intersecting complexities for WASH in challenging contexts: A review. WATER RESEARCH 2022; 209:117909. [PMID: 34906879 DOI: 10.1016/j.watres.2021.117909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
Ensuring access to water, sanitation, and hygiene (WASH) for all requires a thorough understanding of the many contextual complexities that influence access to these services. Complexities spanning environmental, economic, political, and social dimensions, amongst others, can intersect and compound to hinder sustainable access to WASH for certain demographics or entire communities. This is of particular importance for challenging contexts where conventional WASH approaches are ineffective. Targeted approaches are required for these contexts to ensure that communities are not left behind in pursuit of the Sustainable Development Goals. Review of WASH literature identified seven broad types of challenging contexts: challenging environments, transient or environmentally-dependant communities, climate vulnerable communities, remote communities, poor urban communities, refugee camps, and emergency contexts. This review explores the intersecting complexities affecting access to WASH in these challenging contexts and how failure to understand the interconnectedness of these complexities has resulted in WASH solutions that are unaffordable, not inclusive, or unsustainable. To our knowledge, this review is the first of its kind. We emphasise the need to unpack intersecting complexities affecting WASH in challenging contexts, and we believe that incorporating such an approach early in WASH programs can ensure that intersecting complexities are accounted for in the design of WASH solutions. Ultimately, this novel lens may provide critical guidance for WASH programs in challenging contexts, ensuring that WASH solutions are contextually appropriate.
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Affiliation(s)
| | - Nick J Brown
- RMIT University, 124 La Trobe St., Melbourne VIC 3000, Australia
| | - Matthew Currell
- RMIT University, 124 La Trobe St., Melbourne VIC 3000, Australia
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Pereira MA, Marques RC. Sustainable water and sanitation for all: Are we there yet? WATER RESEARCH 2021; 207:117765. [PMID: 34731660 DOI: 10.1016/j.watres.2021.117765] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 05/14/2023]
Abstract
The lack of access to water and sanitation services (WSS) of a considerable share of the world population has been challenging the international community for decades. The proposal of the Millennium Development Goals and, later on, the Sustainable Development Goals (SDGs) by the United Nations (UN) intended to act as a blueprint to achieve a more equitable future for all and, in the case of WSS, "Ensure the availability and sustainable management of water and sanitation for all" (SDG 6). However, the current global pandemic further emphasised the importance of WSS, given the increasing asymmetries faced by billions worldwide, and the gaps between high-income and low- and middle-income nations. For this reason, understanding whether low- and middle-income countries have been approximating towards or deviating from the SDG 6 is crucial to derive and communicate key information for the sake of improved public governance and political decision-making. In this paper, we extend a state-of-the-art methodology based on data envelopment analysis for assessing the convergence of the low- and middle-income UN Member States regarding the SDG 6 between 2016 and 2017. We find that, on average, not only did the Member States converge by decreasing the performance spread and the gap between the best and worst practice frontiers, but also the Level of water stress: freshwater withdrawal as a proportion of available freshwater resources was the indicator in which the majority exhibited the worst performances. In the end, we derive possible policy implications, which, as our results show, are aligned with the recent UN reports on the subject.
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Affiliation(s)
- Miguel Alves Pereira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal; CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal.
| | - Rui Cunha Marques
- CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
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French MA, Fiona Barker S, Taruc RR, Ansariadi A, Duffy GA, Saifuddaolah M, Zulkifli Agussalim A, Awaluddin F, Zainal Z, Wardani J, Faber PA, Fleming G, Ramsay EE, Henry R, Lin A, O'Toole J, Openshaw J, Sweeney R, Sinharoy SS, Kolotelo P, Jovanovic D, Schang C, Higginson EE, Prescott MF, Burge K, Davis B, Ramirez-Lovering D, Reidpath D, Greening C, Allotey P, Simpson JA, Forbes A, Chown SL, McCarthy D, Johnston D, Wong T, Brown R, Clasen T, Luby S, Leder K. A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia. ENVIRONMENT INTERNATIONAL 2021; 155:106679. [PMID: 34126296 DOI: 10.1016/j.envint.2021.106679] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing. METHODS We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements. RESULTS Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5-14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales. CONCLUSIONS Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.
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Affiliation(s)
- Matthew A French
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Ruzka R Taruc
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | | | - Grant A Duffy
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | | | | | - Fitriyanty Awaluddin
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Zainal Zainal
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Jane Wardani
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Peter A Faber
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Genie Fleming
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Emma E Ramsay
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Rebekah Henry
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - John Openshaw
- Woods Institute and the Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Victoria 3145, Australia
| | - Sheela S Sinharoy
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Peter Kolotelo
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Dusan Jovanovic
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Christelle Schang
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Ellen E Higginson
- Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Michaela F Prescott
- Informal Cities Lab, Monash Art Design & Architecture, Monash University, Victoria 3145, Australia
| | - Kerrie Burge
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Brett Davis
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Diego Ramirez-Lovering
- Informal Cities Lab, Monash Art Design & Architecture, Monash University, Victoria 3145, Australia
| | - Daniel Reidpath
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Chris Greening
- Biomedicine Discovery Institute, Department of Microbiology, Monash University, Victoria 3800, Australia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia; International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Steven L Chown
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - David McCarthy
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - David Johnston
- Centre for Health Economics, Monash Business School, Monash University, Victoria 3145, Australia
| | - Tony Wong
- Water Sensitive Cities Institute, Monash University, Victoria 3800, Australia
| | - Rebekah Brown
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Thomas Clasen
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Stephen Luby
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia.
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Ryals R, Bischak E, Porterfield KK, Heisey S, Jeliazovski J, Kramer S, Pierre S. Toward Zero Hunger Through Coupled Ecological Sanitation-Agriculture Systems. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.716140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ecological sanitation (EcoSan) systems capture and sanitize human excreta and generate organic nutrient resources that can support more sustainable nutrient management in agricultural ecosystems. An emerging EcoSan system that is implemented in Haiti and several other contexts globally couples container-based household toilets with aerobic, thermophilic composting. This closed loop sanitation system generates organic nutrient resources that can be used as part of an ecological approach to soil nutrient management and thus has the potential to contribute to Sustainable Development Goals 2 (zero hunger), 6 (clean water and sanitation for all), and 13 (climate change solutions). However, the role of organic nutrient resources derived from human excreta in food production is poorly studied. We conducted a greenhouse experiment comparing the impact of feces-derived compost on crop production, soil nutrient cycling, and nutrient losses with two amendments produced from wastewater treatment (pelletized biosolids and biofertilizer), urea, and an unfertilized control. Excreta-derived amendments increased crop yields 2.5 times more than urea, but had differing carry-over effects. After a one-time application of compost, crop production remained elevated throughout all six crop cycles. In contrast, the carry-over of crop response lasted two and four crop cycles for biosolids and biofertilizer, respectively, and was absent for urea. Soil carbon concentration in the compost amended soils increased linearly through time from 2.0 to 2.5%, an effect not seen with other treatments. Soil nitrous oxide emissions factors ranged from 0.3% (compost) to 4.6% (biosolids), while nitrogen leaching losses were lowest for biosolids and highest for urea. These results indicate that excreta-derived compost provides plant available nutrients, while improving soil health through the addition of soil organic carbon. It also improved biogeochemical functions, indicating the potential of excreta-derived compost to close nutrient loops if implemented at larger scales. If captured and safely treated through EcoSan, human feces produced in Haiti can meet up to 13, 22, and 11% of major crop needs of nitrogen, phosphorus, and potassium, respectively.
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Bick S, Buxton H, Chase RP, Ross I, Adriano Z, Capone D, Knee J, Brown J, Nalá R, Cumming O, Dreibelbis R. Using path analysis to test theory of change: a quantitative process evaluation of the MapSan trial. BMC Public Health 2021; 21:1411. [PMID: 34271913 PMCID: PMC8285873 DOI: 10.1186/s12889-021-11364-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although theory-driven evaluations should have empirical components, few evaluations of public health interventions quantitatively test the causal model made explicit in the theory of change (ToC). In the context of a shared sanitation trial (MapSan) in Maputo, Mozambique, we report findings of a quantitative process evaluation assessing intervention implementation, participant response and impacts on hypothesised intermediary outcomes on the pathway to trial health outcomes. We examine the utility of path analysis in testing intervention theory using process indicators from the intervention's ToC. METHODS Process data were collected through a cross-sectional survey of intervention and control compounds of the MapSan trial > 24-months post-intervention, sampling adult residents and compound leaders. Indicators of implementation fidelity (dose received, reach) and participant response (participant behaviours, intermediary outcomes) were compared between trial arms. The intervention's ToC (formalised post-intervention) was converted to an initial structural model with multiple alternative pathways. Path analysis was conducted through linear structural equation modelling (SEM) and generalised SEM (probit model), using a model trimming process and grouped analysis to identify parsimonious models that explained variation in outcomes, incorporating demographics of respondents and compounds. RESULTS Among study compounds, the MapSan intervention was implemented with high fidelity, with a strong participant response in intervention compounds: improvements were made to intermediary outcomes related to sanitation 'quality' - latrine cleanliness, maintenance and privacy - but not to handwashing (presence of soap / soap residue). These outcomes varied by intervention type: single-cabin latrines or multiple-cabin blocks (designed for > 20 users). Path analysis suggested that changes in intermediary outcomes were likely driven by direct effects of intervention facilities, with little contribution from hygiene promotion activities nor core elements expected to mediate change: a compound sanitation committee and maintenance fund. A distinct structural model for two compound size subgroups (≤ 20 members vs. > 20 members) explained differences by intervention type, and other contextual factors influenced specific model parameters. CONCLUSIONS While process evaluation found that the MapSan intervention achieved sufficient fidelity and participant response, the path analysis approach applied to test the ToC added to understanding of possible 'mechanisms of change', and has value in disentangling complex intervention pathways. TRIAL REGISTRATION MapSan trial registration: NCT02362932 Feb-13-2015.
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Affiliation(s)
- Sarah Bick
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Buxton
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel P Chase
- Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Ian Ross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Drew Capone
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rassul Nalá
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
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Borg FH, Greibe Andersen J, Karekezi C, Yonga G, Furu P, Kallestrup P, Kraef C. Climate change and health in urban informal settlements in low- and middle-income countries - a scoping review of health impacts and adaptation strategies. Glob Health Action 2021; 14:1908064. [PMID: 33847256 PMCID: PMC8049459 DOI: 10.1080/16549716.2021.1908064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Climate change affects human health with those with the least resources being most vulnerable. However, little is known about the impact of climate change on human health and effective adaptation methods in informal settlements in low- and middle-income countries. Objective: The objective of this scoping review was to identify, characterize, and summarize research evidence on the impact of climate change on human health in informal settlements and the available adaptation methods and interventions. Method: A scoping review was conducted using the Arksey and O’Malley framework. The four bibliographic databases PubMed, Web of Science, Embase, and the Cochrane library were searched. Eligibility criteria were all types of peer-reviewed publications reporting on climate change or related extreme weather events (as defined by the United Nations Framework Convention on Climate Change), informal settlements (as defined by UN-Habitat), low- and middle-income countries (as defined by the World Bank) and immediate human health impacts. Review selection and characterization were performed by two independent reviewers using a predefined form. Results: Out of 1197 studies initially identified, 15 articles were retained. We found nine original research articles, and six reviews, commentaries, and editorials. The articles were reporting on the exposures flooding, temperature changes and perceptions of climate change with health outcomes broadly categorized as mental health, communicable diseases, and non-communicable diseases. Six studies had a geographical focus on Asia, four on Africa, and one on South America, the remaining four articles had no geographical focus. One article investigated an adaptation method for heat exposure. Serval other adaptation methods were proposed, though they were not investigated by the articles in this review. Conclusion: There is a paucity of original research and solid study designs. Further studies are needed to improve the understanding of the impact, the most effective adaptation methods and to inform policy making.
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Affiliation(s)
| | - Johanne Greibe Andersen
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark
| | - Catherine Karekezi
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya.,Non-communicable Diseases Alliance Kenya, Nairobi, Kenya
| | - Gerald Yonga
- Non-communicable Diseases Alliance Kenya, Nairobi, Kenya.,Medical Faculty, University of Nairobi, Nairobi, Kenya
| | - Peter Furu
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark
| | - Christian Kraef
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.,Danish Non-communicable Diseases Alliance, Copenhagen, Denmark.,Heidelberg Institute of Global Health, University of Heidelberg, Germany
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23
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Parikh P, Diep L, Hofmann P, Tomei J, Campos LC, Teh TH, Mulugetta Y, Milligan B, Lakhanpaul M. Synergies and trade-offs between sanitation and the sustainable development goals. UCL OPEN ENVIRONMENT 2021; 3:e016. [PMID: 37228800 PMCID: PMC10208324 DOI: 10.14324/111.444/ucloe.000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/18/2021] [Indexed: 05/27/2023]
Abstract
To better leverage opportunities arising out of sustainable and inclusive management of sanitation services there is a need for robust and comprehensive evidence of the wide-ranging benefits that sanitation can deliver. The Sustainable Development Goals (SDGs) provide a comprehensive framework for sustainable development broken down into 169 interconnected Targets which are articulated under 17 Goals. Based on a methodology developed at University College London (UCL), this study identifies linkages between sanitation and the 169 Targets corroborated by published evidence. We show that there are synergies between sanitation and all 17 Goals and 130 (77%) of the Targets, and trade-offs for 28 (17%) of the Targets. We identified 83 Targets (49%) that call for action in the sanitation sector. The results demonstrate the far-reaching benefits that can be unlocked from investment in sanitation, which extend beyond health and spread across sectors. The evidence base for the 17 Goals establishes links that can inform cross-sectoral action, collaborations and investment across governance levels for integrated sanitation solutions. The research provides different stakeholders with a framework that can be applied to context-specific cases and projects. We propose a range of recommendations to policy makers, practitioners and researchers who seek to take this study further to help achieve the SDGs.
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Affiliation(s)
- Priti Parikh
- Engineering for International Development Centre, Bartlett School of Construction Project Management, University College London, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Loan Diep
- Engineering for International Development Centre, Bartlett School of Construction Project Management, University College London, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Pascale Hofmann
- Environmental and Sustainable Development, The Bartlett Development Planning Unit, University College London, 34 Tavistock Square, London WC1H 9EZ, UK
| | - Julia Tomei
- Energy, Resources and Development, UCL Institute for Sustainable Resources, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Luiza C. Campos
- Environmental Engineering, Centre for Urban Sustainability and Resilience, Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, London WC1E 6BT, UK
| | - Tse-Hui Teh
- The Bartlett School of Planning, Central House, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Yacob Mulugetta
- Energy and Development Policy, UCL Department of Science, Technology, Engineering & Public Policy (STEaPP), Shropshire House (4th Fl), 11–20 Caper Street, London WC1E 6JA, UK
| | - Ben Milligan
- Sustainable Development Law and Policy, University of New South Wales, Sydney, NSW 2052, Australia
| | - Monica Lakhanpaul
- Integrated Community Child Health, Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
- Whittington NHS Trust, Magdala Ave, London N19 5NF, London, UK
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24
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Access to Water and Sanitation Services in Brazilian Vulnerable Areas: The Role of Regulation and Recent Institutional Reform. WATER 2021. [DOI: 10.3390/w13060787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Access to water and sanitation services (WSSs) in low- or middle-income countries is constrained by the poverty and vulnerability conditions of the population. In this context, it is urgent to establish public policies for WSSs that will increase the economic access to these services so that they will be more comprehensive and comprise the entire population, ensuring a balance between social and financial objectives. This paper contributes to a better understanding of the provision of WSSs in vulnerable areas and of the difficulty in achieving universal access using Brazil as a case study. The role of regulation in the provision of WSSs in vulnerable areas and the impact of the recent institutional reform that took place last year in that country is discussed. The different experiences analyzed provide interesting lessons that contribute to the improvement of the Brazilian status quo and that, at the same time, can be good practices that can be applied in other countries. One of the main conclusions of this research is related to the contributions that regulation should provide in the universalization of WSSs, mainly when the provision of these services is ruled by a contract. Furthermore, we observed that public authorities have resigned their role in this scope and that they must be more effective and, particularly, more proactive so that universalization can be achieved.
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25
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Green Infrastructure for Sanitation in Settlements in the Global South: A Narrative Review of Socio-Technical Systems. SUSTAINABILITY 2021. [DOI: 10.3390/su13042071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In the developing economies of the Global South, a fundamental challenge in the transition of settlements from rural or periurban to urban is increased environmental contamination as a result of poor sanitation and sanitation management. With governments’ limited ability to connect all neighbourhoods to a city’s existing municipal water, sewerage and other services, decentralised approaches using green infrastructure offer potential to address this challenge. In addition, green infrastructure might facilitate a move towards a holistic response to manage the full water cycle. This paper presents a narrative review of green infrastructure projects, involving constructed wetlands or their variants for wastewater treatment, within vulnerable communities in the Global South. It describes the scale and scope of each project, identifies the challenges of implementation, and reflects on their outcomes for different stakeholder groups. The review demonstrates that decentralised sanitation programs using constructed wetlands for wastewater treatment can provide a range of advantages/benefits/services, dependant on the specific sociocultural, political and biogeophysical contexts of each. Issues of governance and sociocultural appropriateness, rather than technical issues, challenged the implementation of green infrastructure for sanitation in these projects. Projects must be a collaboration between the government, nongovernment organisations and the community. Whether the project is organised from top-down or bottom-up, community consultation is essential. Context will determine the role of the community in the consultation process and the type of information required to guide the design, implementation and governance of the system. In every project to provide decentralised sanitation systems, the community must be participants, not simply beneficiaries.
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26
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Pandey D, Verma S, Verma P, Mahanty B, Dutta K, Daverey A, Arunachalam K. SARS-CoV-2 in wastewater: Challenges for developing countries. Int J Hyg Environ Health 2021; 231:113634. [PMID: 33039922 PMCID: PMC7539828 DOI: 10.1016/j.ijheh.2020.113634] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic that has engulfed the world, has affected the human lives in several aspects. The detection of SARS-CoV-2 in faeces and urine of the infected person, even after viral clearance in the respiratory tract, and its presence in untreated wastewater raises the possibility of fecal-oral transmission in future. The situation is likely to be more aggravated in developing and least developed countries struggling with the problem of ineffective waste disposal system, open defecation, poor sanitation, and limited access to clean drinking water. In this review, the available data on wastewater treatment, sanitation status and healthcare infrastructure from middle- and low-income countries is collected and correlated with the risk associated with the fecal-oral transmission of SARS-CoV-2. The review also highlights the limitation of COVID-19 surveillance through sewage monitoring in these countries owing to the absence of proper sewerage system. An inclusive approach of awareness, prevention, and mitigation from global to the local levels is required to overcome this challenging situation in developing countries.
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Affiliation(s)
- Deepshikha Pandey
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248012, India
| | - Shelly Verma
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248012, India
| | - Priyanka Verma
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248012, India
| | - Biswanath Mahanty
- Department of Biotechnology, Karunya Institute of Technology and Sciences, Coimbatore, 641114, India
| | - Kasturi Dutta
- Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, Odisha, 769008, India
| | - Achlesh Daverey
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248012, India.
| | - Kusum Arunachalam
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248012, India.
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27
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Assessing the Barriers and Risks to Private Sector Participation in Infrastructure Construction Projects in Developing Countries of Middle East. SUSTAINABILITY 2020. [DOI: 10.3390/su13010153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In developing countries, governments are often unable to implement urban infrastructure construction projects (UICPs) on their own, mainly due to budget and financial resource limitations. The participation of the private sector, through public–private partnerships (PPPs), has been considered as an alternative effective method for increasing the efficiency and productivity of urban infrastructure development. However, in many developing countries such as those situated in the Middle East, attracting private sector investments for UICPs uncovers profound challenges that have not ever been comprehensively accounted for and prioritized. To fill this knowledge gap, this study seeks to determine and prioritize the major barriers and risks faced by governments and urban managers in attracting private sector investments through the PPP schemes launched by developing countries in the Middle East. Based on a Delphi study conducted in Iran as an example, the opinions of 60 UICPs experts in both the public and private sectors were collected and analyzed. Results show that technical and organizational barriers and risks were perceived as the most important to private sector participation, followed by economic and financial barriers and risks, and then political and legal barriers and risks.
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28
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David K, Appleton CA, Mukaratirwa S. Environmental contamination and risk factors for geohelminth transmission in three informal settlements in Durban metropole, South Africa. J Parasit Dis 2020; 44:794-805. [PMID: 33184546 PMCID: PMC7596138 DOI: 10.1007/s12639-020-01270-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Informal settlements/slums are characterised by a lack of adequate sanitation and safe drinking water. Contaminated soil and water sources combined with poor hygiene and environmental conditions results in the transmission of soil transmitted helminths to humans. The aim of the present study was to assess environmental contamination and risk factors for geohelminth transmission in three informal settlements in Durban, South Africa. Each settlement had different types of sanitation facilities namely; flush toilets, pit latrines and chemical toilets. Thirty adult members from 30 households from each settlement were interviewed to determine their knowledge, attitudes and behaviour on geohelminth transmission. Furthermore, two hundred soil samples were collected from areas considered potential sources of infection and processed for the detection and identification of geohelminth eggs. Prevalence and intensities of geohelminth infections from school-age children were also assessed. From the total collection in the three settlements, 31.6% (95/190) were positive for geohelminth eggs with Ascaris lumbricoides, Trichuris trichiura and Taenia spp. eggs being recovered. Quarry Road West (57%; 114/200) showed the highest levels of soil contamination followed by Briardene (27%; 54/200) and Smithfield (11%; 22/200). Stool samples collected from 135 children were found to contain parasite eggs of A. lumbricoides and T. trichiura. Prevalences and intensities of infection were highest in Quarry Road West for both A. lumbricoides (42%, 57/135; 6.0eggs/g) and T. trichiura (10%, 14/135; 1.9eggs/g) and 9.6% (13/135) harboured dual infections. Open defaecation by community members was observed as the main contributing factor for the presence of geohelminth eggs in soil.
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Affiliation(s)
- Kelleen David
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Christopher A. Appleton
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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29
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Trimmer JT, Lohman HAC, Byrne DM, Houser SA, Jjuuko F, Katende D, Banadda N, Zerai A, Miller DC, Guest JS. Navigating Multidimensional Social-Ecological System Trade-Offs across Sanitation Alternatives in an Urban Informal Settlement. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:12641-12653. [PMID: 32822180 DOI: 10.1021/acs.est.0c03296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Urban growth in low- and middle-income countries has intensified the need to expand sanitation infrastructure, especially in informal settlements. Sanitation approaches for these settings remain understudied, particularly regarding multidimensional social-ecological outcomes. Guided by a conceptual framework (developed in parallel with this study) re-envisioning sanitation as a human-derived resource system, here we characterize existing and alternative sanitation scenarios in an informal settlement in Kampala, Uganda. Combining two core research approaches (household survey analysis, process modeling), we elucidate factors associated with user satisfaction and evaluate each scenario's resource recovery potential, economic implications, and environmental impacts. We find that existing user satisfaction is associated with factors including cleaning frequency, sharing, and type of toilets, and we demonstrate that alternative sanitation systems may offer multidimensional improvements over existing latrines, drying beds, and lagoons. Transitioning to anaerobic treatment could recover energy while reducing overall net costs by 26-65% and greenhouse gas emissions by 38-59%. Alternatively, replacing pit latrines with container-based facilities greatly improves recovery potential in most cases (e.g., a 2- to 4-fold increase for nitrogen) and reduces emissions by 46-79%, although costs increase. Overall, this work illustrates how our conceptual framework can guide empirical research, offering insight into sanitation for informal settlements and more sustainable resource systems.
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Affiliation(s)
- John T Trimmer
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 North Mathews Avenue, Urbana, Illinois 61801, United States
| | - Hannah A C Lohman
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 North Mathews Avenue, Urbana, Illinois 61801, United States
| | - Diana M Byrne
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 North Mathews Avenue, Urbana, Illinois 61801, United States
| | - Stephanie A Houser
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 North Mathews Avenue, Urbana, Illinois 61801, United States
| | - Fulgensio Jjuuko
- Community Integrated Development Initiatives, P.O. Box 692, Kampala, Uganda
| | - David Katende
- Community Integrated Development Initiatives, P.O. Box 692, Kampala, Uganda
| | - Noble Banadda
- Department of Agricultural & Biosystems Engineering, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Assata Zerai
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Daniel C Miller
- Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign, 1102 South Goodwin Avenue, Urbana, Illinois 61801, United States
| | - Jeremy S Guest
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 North Mathews Avenue, Urbana, Illinois 61801, United States
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30
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Pathogen flows from on-site sanitation systems in low-income urban neighborhoods, Dhaka: A quantitative environmental assessment. Int J Hyg Environ Health 2020; 230:113619. [PMID: 32942223 DOI: 10.1016/j.ijheh.2020.113619] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/16/2020] [Accepted: 08/27/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite wide usage of on-site sanitation, there is limited field-based evidence on the removal or release of pathogens from septic tanks and other primary treatment systems, such as anaerobic baffled reactors (ABR). In two low-income areas in Dhaka, we conducted a cross-sectional study to explore pathogen loads discharged from commonly used on-site sanitation-systems and their transport in nearby drains and waterways. METHODS We collected samples of drain water, drain sediment, canal water, and floodwater from April-October 2019. Sludge, supernatant, and effluent samples were also collected from septic tanks and ABRs. We investigated the presence and concentration of selected enteric pathogens (Shigella, Vibrio cholerae (V. cholerae), Salmonella Typhi (S. Typhi), Norovirus Genogroup-II (NoV-GII), and Giardia) and presence of Cryptosporidium in these samples using quantitative polymerase chain reaction (qPCR).The equivalent genome copies (EGC) of individual pathogens were estimated in each sample by interpolation of the mean Ct value to the corresponding standard curve and the dilution factor for each sample type. Absolute quantification was expressed as log10 EGC per 100 mL for the water samples and log10 EGC per gram for the sediment samples. RESULTS Among all samples tested (N = 151), 89% were contaminated with Shigella, 68% with V. cholerae and NoV-GII, 32% with Giardia, 17% with S. Typhi and 6% with Cryptosporidium. A wide range of concentration of pathogens [range: mean log10 concentration of Giardia = 0.74 EGC/100 mL in drain ultrafiltration samples to mean log10 concentration of NoV-GII and Giardia = 7.11 EGC/100 mL in ABR sludge] was found in all environmental samples. The highest pathogen concentrations were detected in open drains [range: mean log10 concentration = 2.50-4.94 EGC/100 mL], septic tank effluent [range: mean log10 concentration = 3.32-4.65 EGC/100 mL], and ABR effluent [range: mean log10 concentration = 2.72-5.13 EGC/100 mL]. CONCLUSIONS High concentrations of pathogens (particularly NoV-GII, V.cholerae and Shigella) were frequently detected in environmental samples from two low-income urban neighbourhoods of Dhaka city. The numerous environmental exposure pathways for children and adults make these findings of public health concern. These results should prompt rethinking of how to achieve safe sanitation solutions that protect public health in dense low-income areas. In particular, improved management and maintenance regimes, further treatment of liquid effluent from primary treatment processes, and appropriate application of onsite, decentralised and offsite sanitation systems given the local context.
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Achore M, Bisung E, Kuusaana ED. Coping with water insecurity at the household level: A synthesis of qualitative evidence. Int J Hyg Environ Health 2020; 230:113598. [PMID: 32862072 DOI: 10.1016/j.ijheh.2020.113598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
Water insecurity is a key public health and developmental challenge for many communities across the world. Using a meta-ethnographic synthesis, this study examines how households cope with water insecurity, as well as the socio-economic consequences and determinants of water insecurity coping strategies. A systematized keyword search was conducted in various electronic databases (PubMed, CINAHL EBSCOHost, Embase Ovid, Science Direct, Medline, Global Health, SCOPUS, Google and Google scholar). Out of 1352 potential articles, 21 studies were selected for review. Households employed nine key coping strategies. These strategies include water storage, construction of alternative water source, water sharing and borrowing from social networks, buying water from private vendors, water management and reuse, illegal connections to public water networks, water harvesting, fetching water from distant sources, and water treatment to improve the quality. Some of these coping strategies had far-reaching health and economic consequences, including the risk of water contamination, adverse psychosocial health, and impacts on household savings. We found that poor households, due to their over-reliance on short term labour-intensive and time-consuming coping strategies, are further economically disadvantaged by water insecurity. From a policy perspective, we recommend that investments in effective and efficient water supply infrastructure are needed to help alleviate the day-to-day hassles of water users. While policymakers are looking for long term solutions to these problems, some of the coping strategies identified in this synthesis, such as water conservation, water reuse, and purification of water before consumption, could be encouraged as supplementary strategies to meet households' immediate water needs.
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Affiliation(s)
- Meshack Achore
- School of Kinesiology and Health Studies, Queen's University Kingston, ON, Canada.
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University Kingston, ON, Canada
| | - Elias D Kuusaana
- Department of Real Estate and Land Management, University for Development Studies, Wa Upper West Region, Ghana
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Gachohi J, Karanja S, Mwangi C. Challenges facing harm reduction interventions in the era of COVID-19 in Africa. SCIENTIFIC AFRICAN 2020; 9:e00506. [PMID: 33251390 PMCID: PMC7391018 DOI: 10.1016/j.sciaf.2020.e00506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- John Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya
- Washington State University, Global Health Kenya, Kenya
| | - Simon Karanja
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Catherine Mwangi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya
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33
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Snyder JS, Prentice-Mott G, Boera C, Mwaki A, Alexander KT, Freeman MC. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155298. [PMID: 32717846 PMCID: PMC7432725 DOI: 10.3390/ijerph17155298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022]
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, 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.
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Affiliation(s)
- Jedidiah S. Snyder
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA 30322, USA; (J.S.S.); (G.P.-M.)
| | - Graeme Prentice-Mott
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA 30322, USA; (J.S.S.); (G.P.-M.)
| | | | - Alex Mwaki
- Safe Water & AIDS Project, Kisumu 40100, Kenya;
| | | | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA 30322, USA; (J.S.S.); (G.P.-M.)
- Correspondence:
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Holcomb DA, Knee J, Sumner T, Adriano Z, de Bruijn E, Nalá R, Cumming O, Brown J, Stewart JR. Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique. Int J Hyg Environ Health 2020; 226:113496. [PMID: 32135507 PMCID: PMC7174141 DOI: 10.1016/j.ijheh.2020.113496] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Identifying the origin of fecal contamination can support more effective interventions to interrupt enteric pathogen transmission. Microbial source tracking (MST) assays may help to identify environmental routes of pathogen transmission although these assays have performed poorly in highly contaminated domestic settings, highlighting the importance of both diagnostic validation and understanding the context-specific ecological, physical, and sociodemographic factors driving the spread of fecal contamination. We assessed fecal contamination of compounds (clusters of 2-10 households that share sanitation facilities) in low-income neighborhoods of urban Maputo, Mozambique, using a set of MST assays that were validated with animal stool and latrine sludge from study compounds. We sampled five environmental compartments involved in fecal microbe transmission and exposure: compound water source, household stored water and food preparation surfaces, and soil from the entrance to the compound latrine and the entrances to each household. Each sample was analyzed by culture for the general fecal indicator Escherichia coli (cEC) and by real-time PCR for the E. coli molecular marker EC23S857, human-associated markers HF183/BacR287 and Mnif, and GFD, an avian-associated marker. We collected 366 samples from 94 households in 58 compounds. At least one microbial target (indicator organism or marker gene) was detected in 96% of samples (353/366), with both E. coli targets present in the majority of samples (78%). Human targets were frequently detected in soils (59%) and occasionally in stored water (17%) but seldom in source water or on food surfaces. The avian target GFD was rarely detected in any sample type but was most common in soils (4%). To identify risk factors of fecal contamination, we estimated associations with sociodemographic, meteorological, and physical sample characteristics for each microbial target and sample type combination using Bayesian censored regression for target concentration responses and Bayesian logistic regression for target detection status. Associations with risk factors were generally weak and often differed in direction between different targets and sample types, though relationships were somewhat more consistent for physical sample characteristics. Wet soils were associated with elevated concentrations of cEC and EC23S857 and odds of detecting HF183. Water storage container characteristics that expose the contents to potential contact with hands and other objects were weakly associated with human target detection. Our results describe a setting impacted by pervasive domestic fecal contamination, including from human sources, that was largely disconnected from the observed variation in socioeconomic and sanitary conditions. This pattern suggests that in such highly contaminated settings, transformational changes to the community environment may be required before meaningful impacts on fecal contamination can be realized.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Zaida Adriano
- We Consult, Maputo, Mozambique; Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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35
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Anthonj C, Tracy JW, Fleming L, Shields KF, Tikoisuva WM, Kelly E, Thakkar MB, Cronk R, Overmars M, Bartram J. Geographical inequalities in drinking water in the Solomon Islands. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 712:135241. [PMID: 31843312 DOI: 10.1016/j.scitotenv.2019.135241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 06/10/2023]
Abstract
Sustainable Development Goal 6.1 seeks to "by 2030, achieve universal and equitable access to safe and affordable drinking water", which is challenging particularly in Small Island Developing States (SIDS) and Pacific Island Countries (PIC). We report drinking water sources and services in the Solomon Islands and examine geographical inequalities. Based on two quantitative baseline datasets of n = 1,598 rural and n = 1,068 urban households, we analyzed different drinking water variables (source type, collection time, amount, use, perceived quality, storage, treatment) and a composite index, drinking water service level. We stratified data by urban and rural areas and by province, mapped, and contextualized them. There are substantive rural-urban drinking water inequalities in the Solomon Islands. Overall, urban households are more likely to: use improved drinking water sources, need less time to collect water, collect more water, store their water more safely, treat water prior to consumption, perceive their water quality as better and have an at least basic drinking water service than rural households. There are also provincial and center-periphery inequalities in drinking water access, with more centrally located provinces using piped water supplies and more distant and remote provinces using rainwater and surface water as their primary source. There are also inter-national inequalities. Out of all PICs, the Solomon Islands have among the lowest access to basic drinking water services: 92% of urban and 55% of rural households. Of all SIDS, PICs are least serviced. This study shows that drinking water inequality is a critical issue, and highlights that all identified dimensions of inequality - rural-urban, provincial, center-periphery and inter-national - need to be explicitly recognized and addressed and included in pro-equity monitoring, policy and programming efforts by the Solomon Islands Government and stakeholders to reduce inequalities as per the Agenda 2030.
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Affiliation(s)
- Carmen Anthonj
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - J Wren Tracy
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Lisa Fleming
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Katherine F Shields
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Department of Geography, University of Oregon, Eugene, OR, United States
| | - Waqairapoa M Tikoisuva
- UNICEF Pacific, Fiji Development Bank Building, 360 Victoria Parade, Suva, Fiji, United States
| | - Emma Kelly
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Mamita Bora Thakkar
- UNICEF Solomon Islands, ANZ Haus, Kukum Highway, Ranadi, Honiara P.O Box 1786 Solomon Islands
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Marc Overmars
- UNICEF Pacific, Fiji Development Bank Building, 360 Victoria Parade, Suva, Fiji, United States
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; School of Civil Engineering, University of Leeds, United Kingdom
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