1
|
Sprouse L, Lebu S, Nguyen J, Muoghalu C, Uwase A, Guo J, Baldwin-SoRelle C, Anthonj C, Simiyu SN, Akudago JA, Manga M. Shared sanitation in informal settlements: A systematic review and meta-analysis of prevalence, preferences, and quality. Int J Hyg Environ Health 2024; 260:114392. [PMID: 38788338 DOI: 10.1016/j.ijheh.2024.114392] [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: 12/08/2023] [Revised: 05/03/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Shared sanitation facilities are not considered a type of basic sanitation by the WHO/UNICEF Joint Monitoring Programme (JMP), though they may be the only alternative to open defecation in urban informal settlements. Additionally, JMP indicators for sanitation do not cover aspects related to the quality of shared sanitation, such as those outlined in the Human Right to Water and Sanitation (HRTWS) framework. Data on the prevalence of shared sanitation within informal settlement areas is limited, and there is a need to understand user preferences, experiences, and barriers to the use of shared sanitation to inform effective policy and practice. This systematic review aims to summarize the prevalence and number of households sharing sanitation in informal settlements globally, as well as user experiences and barriers to successful implementation of shared sanitation. We included studies available in English and published after January 1, 2000. We retrieved 4741 articles from seven databases and included a total of 167 relevant publications. Among included studies, 54 reported the prevalence of shared sanitation in informal settlements, and 138 studies reported on user perceptions and experiences related to shared sanitation quality. A meta-analysis of studies reporting the prevalence of shared sanitation in informal settlements globally revealed an estimated overall prevalence of 67% [95% CI: 61%-73%]. Commonly reported user preferences included cleanliness to promote continued use of shared facilities, privacy with a lockable door, facilities for menstrual hygiene management, safety and protection against violence, 24/7 access, proper lighting, and shared responsibility for facility management - which align with the HRTWS framework and represent barriers to shared sanitation use. Based on the findings of this review, we recommend including the number of households or people sharing a sanitation facility in monitoring of shared sanitation quality, locating sanitation facilities within compounds, where applicable, and promoting safety, dignity, and privacy of all users in the development of shared sanitation quality indicators.
Collapse
Affiliation(s)
- Lauren Sprouse
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | - Sarah Lebu
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | - Jackqueline Nguyen
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | - Chimdi Muoghalu
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | - Andromede Uwase
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | - Jiahui Guo
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA
| | | | - Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Sheillah N Simiyu
- African Population and Health Research Center, Manga Close, Off Kirawa Road, P.O Box 10787-00100, Nairobi, Kenya
| | - John Apambilla Akudago
- Global Programs, Habitat for Humanity International, 1202 Aspen Meadows Dr NE, Rio Rancho, NM, 87144, USA
| | - Musa Manga
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, 4114 McGavran Greenberg Hall, Campus Box # 7431, NC, 27599, Chapel Hill, NC, USA; Department of Construction Economics and Management, College of Engineering, Design, Art and Technology (CEDAT), Makerere University, P.O. Box 7062, Kampala, Uganda.
| |
Collapse
|
2
|
Sustainability in Peri-Urban Informal Settlements: A Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14137591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study of peri-urbanization attracted attention in the final quarter of the 20th century, due to the pace it acquired worldwide and the implication that urbanization and overall settlement patterns have on social sustainability and development. Theoretical and conceptual achievements are remarkable. Multi-country collaboration has produced a growing body of research on sustainability and peri-urban settlements. There is a lack, however, of a review of the practices of peri-urban informal settlements, the predominant mode of urban expansion, mainly in developing and rapidly urbanizing regions of the world. The purpose is, then, to systematize, from recent literature, the knowledge of the context, challenges, and practices, as well as their impacts and potential courses of action, to ensure sustainability in human–natural complex of the territory beyond urban cores, suburbs, or slums. A systematic review approach was adopted, for articles published in reputable journals, with support of previous reviews, books, and reports. A pragmatist combination of content analysis and critical review identified core topics and highlighted contrasting views. An analytical framework is proposed. Four categories—drivers, challenges and practices, impact, and future trends—are proposed as an adequate approach to systematizing the literature. The review finds that the practices focus on service and resource provision, on regulations to approximate informal to formal institutions, and on an economy founded on the resource base and service provision. This review provides insights on future trends and research topics.
Collapse
|
3
|
Mulatya DM, Were V, Olewe J, Mbuvi J. Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya. PLoS One 2021; 16:e0248223. [PMID: 33939698 PMCID: PMC8092787 DOI: 10.1371/journal.pone.0248223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/22/2021] [Indexed: 12/04/2022] Open
Abstract
Poor sanitation worldwide leads to an annual loss of approximately $222.9 billion and is the second leading cause of Disability-Adjusted Life Years (DALY’s) lost due to diarrhoea. Yet in Kenya, the slow rate and levels at which the household’s access improved sanitation facilities remain a concern, and it is unknown if the cost of new technologies is a barrier to access. This study assessed the maximum willingness to pay (WTP) for SAFI and SATO sanitation products and identified those factors that affect the willingness to pay (WTP) valuation estimates by households in three counties in Kenya. It used quantitative economic evaluation research integrated within a cross-sectional survey. Contingent valuation method (CVM) was used to determine the maximum WTP for sanitation in households. We used the logistic regression model in data analysis. A total of 211 households were interviewed in each county, giving a total sample size of 633 households. The mean WTP for SAFI latrines was $153.39 per household, while the mean WTP for SATO pans and SATO stools was $11.49 and $14.77 respectively. For SAFI latrines, households in Kakamega were willing to pay $6.6 more than average while in Siaya, the households were willing to pay $5.1 less than the average. The main determinants of households WTP for the two sanitation products included household’s proximity to the toilet (p = 0.0001), household income (β = .2245741, p = 0.004), sanitation product (β = -2968.091; p = 0.004), socioeconomic status (β = -3305.728, p = 0.004) and a household’s satisfaction level with the current toilet (β = -4570.602; p = 0.0001). Increased proximity of households to the toilet, higher incomes, and providing loan facilities or subsidy to poor households could increase the demand for these sanitation technologies.
Collapse
Affiliation(s)
- Diana Mutuku Mulatya
- USAID/Kenya Integrated Water, Sanitation and Hygiene Project, Nairobi, Kenya
- * E-mail:
| | - Vincent Were
- Health Economics Research Unit, Kenya Medical Research Institute Wellcome Trust, Nairobi, Kenya
| | | | - Japheth Mbuvi
- USAID/Kenya Integrated Water, Sanitation and Hygiene Project, Nairobi, Kenya
| |
Collapse
|
4
|
Tidwell JB, Chipungu J, Ross I, Antwi-Agyei P, Alam MU, Tumwebaze IK, Norman G, Cumming O, Simiyu S. Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings. Am J Trop Med Hyg 2020; 104:429-432. [PMID: 33241782 PMCID: PMC7866357 DOI: 10.4269/ajtmh.20-0985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
Shared sanitation is not currently accepted within the international normative definitions of "basic" or "safely managed" sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring.
Collapse
Affiliation(s)
- James B. Tidwell
- World Vision Inc., Washington, District of Columbia
- Harvard Kennedy School of Government, Cambridge, Massachusetts
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ian Ross
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Prince Antwi-Agyei
- NHance Development Partners Ltd, Kumasi, Ghana
- University of Energy and Natural Resources, Sunyani, Ghana
| | - Mahbub-Ul Alam
- International Centre for Diarrhoeal Disease Research in Bangladesh, Dhaka, Bangladesh
| | | | - Guy Norman
- Urban Research, Guildford, United Kingdom
| | - Oliver Cumming
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
5
|
Alam MU, Sharior F, Ferdous S, Ahsan A, Ahmed T, Afrin A, Sarker S, Akand F, Archie RJ, Hasan K, Renouf R, Drabble S, Norman G, Rahman M, Tidwell JB. Strategies to Connect Low-Income Communities with the Proposed Sewerage Network of the Dhaka Sanitation Improvement Project, Bangladesh: A Qualitative Assessment of the Perspectives of Stakeholders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197201. [PMID: 33019716 PMCID: PMC7579280 DOI: 10.3390/ijerph17197201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
In Bangladesh, approximately 31% of urban residents are living without safely managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing low-income communities (LICs) under a sewerage connection within the proposed sewerage network plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bills equally among sharing households, or by users per household. Participants also suggested the government’s cooperation with development-partners/NGOs to ensure sewerage connection construction, operation, and maintenance and prerequisite policy changes such as assuring land tenure.
Collapse
Affiliation(s)
- Mahbub-Ul Alam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
- Correspondence:
| | - Fazle Sharior
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Sharika Ferdous
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Atik Ahsan
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Tanvir Ahmed
- Department of Civil Engineering, Bangladesh University of Engineering and Technology, Dhaka 1000, Bangladesh;
| | - Ayesha Afrin
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Supta Sarker
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Farhana Akand
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - Rownak Jahan Archie
- Institute of Statistical Research and Training, University of Dhaka, Dhaka 1000, Bangladesh;
| | - Kamrul Hasan
- Dhaka Water Supply and Sewerage Authority (DWASA), Dhaka 1215, Bangladesh;
| | - Rosie Renouf
- Water & Sanitation for the Urban Poor (WSUP), London ECV4 6AL, UK; (R.R.); (S.D.); (G.N.)
| | - Sam Drabble
- Water & Sanitation for the Urban Poor (WSUP), London ECV4 6AL, UK; (R.R.); (S.D.); (G.N.)
| | - Guy Norman
- Water & Sanitation for the Urban Poor (WSUP), London ECV4 6AL, UK; (R.R.); (S.D.); (G.N.)
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka 1212, Bangladesh; (F.S.); (S.F.); (A.A.); (A.A.); (S.S.); (F.A.); (M.R.)
| | - James B. Tidwell
- Harvard Kennedy School of Government, Cambridge, MA 02138, USA;
- World Vision Inc., Washington, DC 20002, USA
| |
Collapse
|
6
|
Ellis A, McClintic EE, Awino EO, Caruso BA, Arriola KRJ, Ventura SG, Kowalski AJ, Linabarger M, Wodnik BK, Webb-Girard A, Muga R, Freeman MC. Practices and Perspectives on Latrine Use, Child Feces Disposal, and Clean Play Environments in Western Kenya. Am J Trop Med Hyg 2020; 102:1094-1103. [PMID: 32124727 PMCID: PMC7204574 DOI: 10.4269/ajtmh.19-0389] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Exposure to fecal pathogens contributes to childhood diarrhea and stunting, causing harmful short- and long-term impacts to health. Understanding pathways of child fecal exposure and nutritional deficiencies is critical to informing interventions to reduce stunting. Our aim was to explore determinants of latrine use, disposal of child feces, and perceptions and provisions of a safe and clean child play environment among families with children under two (CU2) years to inform the design of a behavior change intervention to address water, sanitation, and hygiene (WASH), and nutrition behaviors. In 2016, we conducted a mixed-methods formative research in western Kenya. We conducted 29 key informant interviews with community leaders, health workers, and project staff; 18 focus group discussions with caregivers of CU2 years; and 24 semi-structured household observations of feeding, hygiene, and sanitation behaviors. We used the capability, opportunity, motivation, and behavior model as our theoretical framework to map caregiver behavioral determinants. Latrine use barriers were lack of latrines, affordability of lasting materials, and social acceptability of unobserved open defecation. Barriers to safe disposal of child feces were lack of latrines, time associated with safe disposal practices, beliefs that infant feces were not harmful, and not knowing where children had defecated. Primary barriers of clean play environments were associated with creating and maintaining play spaces, and shared human and animal compounds. The immediate cost to practicing behaviors was perceived as greater than the long-term potential benefits. Intervention design must address these barriers and emphasize facilitators to enable optimal WASH behaviors in this context.
Collapse
Affiliation(s)
- Anna Ellis
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emilie E McClintic
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily O Awino
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kimberly R J Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sandra Gomez Ventura
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alysse J Kowalski
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Molly Linabarger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amy Webb-Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
7
|
Tidwell JB, Chipungu J, Chilengi R, Curtis V, Aunger R. Using a theory-driven creative process to design a peri-urban on-site sanitation quality improvement intervention. BMC Public Health 2019; 19:565. [PMID: 31088432 PMCID: PMC6518808 DOI: 10.1186/s12889-019-6898-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Behavior change interventions have been developed by drawing from many different theories using design processes of varying specificity. We describe the development of a behavior change intervention to improve on-site peri-urban sanitation quality in Lusaka, Zambia using the Behavior Centered Design (BCD) framework to explain the results of the process applied to improving the quality of shared peri-urban sanitation and compare them to similar interventions. METHODS We used the BCD behavioral determinants model to synthesize the data from our literature review and formative research. Then, we partnered with creative professionals using a design process to develop a theory-driven on-site peri-urban sanitation intervention. Particular attention was paid to the implications of using BCD for intervention development on improving its effectiveness, increasing the contributions to knowledge for other behaviors and settings, and advancing the discipline of applied behavioral science. RESULTS Based on findings from a literature review and formative research, we designed an intervention to encourage landlords to improve their toilets by making them more accessible, desirable, hygienic, and sustainable. The intervention involved landlords meeting in facilitated groups every 2 weeks with individual follow-up after each meeting. The meetings presented surprising "hidden camera"-style videos to reveal tenants' perspectives, used participatory activities to help landlords reevaluate the benefits they would derive from improving sanitation on their plots, and provided practical guidance and mechanisms to facilitate the performance of construction and cleaning behaviors. CONCLUSIONS Using the BCD framework provided an easy-to-follow intervention design process. The resulting intervention is highly creative and multi-faceted, with each element having a theoretical role in an explicit theory of change. The development of this theory-driven intervention advances applied behavioral science by facilitating evaluation of each of the behavior change techniques and the overall delivery mechanism hypothesized to change the target behaviors. This informs the adaptation of these findings to improving on-site sanitation in other settings and the iterative development of the BCD model, which can be used to more effectively change other behaviors.
Collapse
Affiliation(s)
- James B. Tidwell
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Jenala Chipungu
- Center for Infectious Disease Research in Zambia, Plot 34620, Alick Nkhata Road, Lusaka, Zambia
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Plot 34620, Alick Nkhata Road, Lusaka, Zambia
| | - Val Curtis
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Robert Aunger
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| |
Collapse
|