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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.
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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.
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Amin N, Haque R, Rahman MZ, Rahman MZ, Mahmud ZH, Hasan R, Islam MT, Sarker P, Sarker S, Adnan SD, Akter N, Johnston D, Rahman M, Liu P, Wang Y, Shirin T, Rahman M, Bhattacharya P. Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161424. [PMID: 36623655 PMCID: PMC9822545 DOI: 10.1016/j.scitotenv.2023.161424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 05/25/2023]
Abstract
The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020-January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log10 CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13-18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30-1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.
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Affiliation(s)
- Nuhu Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Institute for Sustainable Futures, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia.
| | - Rehnuma Haque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Medicine, Stanford University, Stanford, CA, USA
| | - Md Ziaur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hayat Mahmud
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rezaul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tahmidul Islam
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE 114 28 Stockholm, Sweden; WaterAid, Bangladesh
| | - Protim Sarker
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Supriya Sarker
- Directorate General of Health Services (DGHS), Bangladesh
| | | | - Nargis Akter
- Water, Sanitation & Hygiene (WASH) section, UNICEF, Bangladesh
| | - Dara Johnston
- Water, Sanitation & Hygiene (WASH) section, UNICEF, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh
| | - Pengbo Liu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, USA
| | - Yuke Wang
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, USA
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Prosun Bhattacharya
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE 114 28 Stockholm, Sweden
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Antwi-Agyei P, Monney I, Amaning Adjei K, Kweyu R, Simiyu S. Shared but Clean Household Toilets: What Makes This Possible? Evidence from Ghana and Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4271. [PMID: 35409952 PMCID: PMC8998870 DOI: 10.3390/ijerph19074271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Shared sanitation facilities are not considered as basic sanitation owing to cleanliness and accessibility concerns. However, there is mounting evidence that some shared household toilets have a comparable level of service as private toilets. This study examined the factors that contribute to the quality of shared household toilets in low-income urban communities in Ghana and Kenya. The study design comprised household surveys and field inspections. Overall, 843 respondents were interviewed, and 838 household shared sanitation facilities were inspected. Cleanliness scores were computed from the facility inspections, while a total quality score was calculated based on 13 indicators comprising hygiene, privacy, and accessibility. Regression analyses were conducted to determine predictors of cleanliness and the overall quality of the shared sanitation facilities. More than four out of five (84%) shared toilets in Ghana (N = 404) were clean, while in Kenya (N = 434), nearly a third (32%) were clean. Flush/pour-flush toilets were six times (p < 0.01 aOR = 5.64) more likely to be clean. A functional outside door lock on a toilet facility and the presence of live-in landlords led to a threefold increase (p < 0.01 aOR = 2.71) and a twofold increase (p < 0.01 aOR = 1.92), respectively in the odds of shared sanitation cleanliness. Sanitation facilities shared by at most five households (95% CI: 6−7) were generally clean. High-quality shared toilets had live-in landlords, functional door locks, and were water-dependent. Further studies on innovative approaches to maintaining the quality of these high-quality shared toilets are needed to make them eligible for classification as basic sanitation considering the increasing reliance on the facilities.
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Affiliation(s)
- Prince Antwi-Agyei
- Regional Centre of Energy and Environmental Sustainability (RCEES), Civil and Environmental Engineering Department, School of Engineering, University of Energy and Natural Resources (UENR), P.O. Box 214, Sunyani BS0061, Ghana
| | - Isaac Monney
- Department of Environmental Health and Sanitation Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, P.O. Box M40, Mampong 3JG3+PFQ, Ghana;
| | - Kwaku Amaning Adjei
- Department of Civil Engineering, Regional Water and Environmental Sanitation Centre (RWESCK), Kwame Nkrumah University of Science and Technology (KNUST), PMB, University Post Office, Kumasi AK448, Ghana;
| | - Raphael Kweyu
- Department of Geography, Kenyatta University, P.O. Box 43844, Nairobi 00100, Kenya;
| | - Sheillah Simiyu
- Urbanisation and Well-Being Unit, African Population & Health Research Center, P.O. Box 10787, Nairobi 00100, Kenya;
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Mwai J, Nyole D, Abdi M, Ahmed I, Mutai J, Kaduka L, Ndemwa P, Omogi J. Assessment of water, sanitation and hygiene practices for prevention and control of COVID-19 in Kenya. Int Health 2021; 14:597-603. [PMID: 34865029 PMCID: PMC9623497 DOI: 10.1093/inthealth/ihab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/08/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Safely managed water, sanitation and hygiene (WASH) services are an essential part of preventing and protecting human health during infectious disease outbreaks, including the current coronavirus disease 2019 (COVID-19) pandemic. Additionally, adherence to COVID-19 measures, including washing hands using soap and proper waste disposal, no doubt can improve containment of the virus. Methods A cross-sectional survey was conducted in Kilifi and Mombasa Counties in Kenya. A total of 612 quantitative data were collected using a mobile data collection tool Open Data Kit. Parametric and non-parametric tests were used to examine factors associated with WASH practices and control of COVID-19 in Kenya. Results More than half of the respondents were from Kilifi, 431 (70.4%) were female and the mean age was 38.2±14.8 y. Households in Kilifi were most likely not to have enough water, while Mombasa households were more likely to pay for water. Sanitation coverage was 47.6%, with more than half sharing sanitation facilities. Sharing of latrines was significantly associated with county and income level. Accessing soap was worse compared with the month prior to the survey, only 3.9% had their garbage collected by formal service providers and only 17% reported wearing any protective gear while handling waste at home. Conclusions Water is disproportionately available in the two counties, with low sanitation coverage. There is low knowledge on hand washing and inadequate waste disposal services.
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Affiliation(s)
- J Mwai
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | | | - M Abdi
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | - I Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | - J Mutai
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | - L Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | - P Ndemwa
- Centre for Public Health Research, Kenya Medical Research Institute, Kenya
| | - J Omogi
- Jomo Kenyatta University of Agriculture and Technology
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