No evidence that current sanitation interventions stop faecal exposure

A systematic review [1] of 29 studies found “little to no effect from sanitation interventions” on “faecal-oral transmission of enteric and other pathogens”. The transmission pathways reviewed included “faecal pathogens or indicator bacteria in drinking water, hand contamination, sentinel toys, food, household and latrine surfaces and soil, as well as flies and observations of human faeces”.

There was some evidence showing the association of sanitation “with reductions in flies and a small effect on observations of faeces”. There was also evidence showing “an inverse relationship between the distance of a water supply from a latrine and level of faecal contamination of such water supply”.

The authors of the review conclude that current sanitation efforts in low-income countries are ineffective and unable to prevent contamination along well-known pathways. This may be because “interventions often fail to achieve universal coverage or use”, which is the subject of another systematic review [2].

As expected from researchers, they are also recommend that more rigorous studies are required to investigate the impact of sanitation interventions on multiple transmission pathways.

Unfortunately this important study is not available as an open access article.

[1] Sclar GD, Penakalapati G, Amato HK, Garn JV, Alexander K, Freeman MC, Clasen T. Assessing the impact of sanitation on indicators of fecal exposure along principal transmission pathways : a systematic review. International Journal of Hygiene and Environmental Health. 2016 Oct 1.DOI:10.1016/j.ijheh.2016.09.021

[2] Garn, J.V., Sclar, G.D., Freeman, M.C., Alexander, K.T., Penakalapati, G., Brooks, P.,Rehfuess, E.A., Clasen, T.F. The impact of sanitation interventions on latrine coverage and latrine use : a systematic review and meta-analysis. International Journal of Hygiene and Environmental Health. 2016 Oct 11.DOI: 10.1016/j.ijheh.2016.10.001

Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia

Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia. PLoS Neg Trop Dis, Mar 2015.

• Full text 

Authors: Séverine Thys , Kabemba E. Mwape, et al.

Livestock owners from small scale farms are most vulnerable for Neglected Zoonotic Diseases (NZD) in developing countries and their risk behavior leads to more intense and complex transmission patterns. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. However the socio-cultural determinants regarding its control remain unclear. We hypothesize that via a bottom-up culture-sensitive approach, innovative control strategies can be developed that are more adapted to the local reality and more sustainable than current interventions.

By assessing the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia, we found that more than health, seeking privacy underlies motivation to use latrines or not. The identified taboos related to sanitation practices are in fact explained by the matri- or patrilineal descent and because men are responsible for building latrines, sanitation programs should focus more often on men’s knowledge and beliefs. In order to contribute to breaking the vicious cycle between poverty and poor health among livestock owners in developing countries, disease control strategies should always consider the socio-cultural context.

WaterSHED – Rural Consumer Sanitation Adoption Study in Cambodia

Rural Consumer Sanitation Adoption Study: An Analyis of Rural Consumers in the Emerging Sanitation Market in Cambodia, 2014.

• Link

WaterSHED has published the findings from its comprehensive review of rural consumer sanitation adoption in Cambodia. The study evaluates WaterSHED’s Hands-Off sanitation marketing program, which was designed to catalyze the market for improved sanitation in rural Cambodia by stimulating household demand and improving the supply of affordable sanitation options for rural households. 

The study confirms that the WaterSHED program has resulted in a substantial acceleration in improved latrine coverage and usage in the study areas. Household consumers are now able to access an improved latrine more easily and more cheaply than before.

New distribution and sales mechanisms are increasing household awareness of and exposure to more affordable latrine products and increasing motivation to invest in an improved latrine.

Enterprises are demonstrating that they serve at least some segments of the previously unserved rural market.

Nonetheless, significant challenges still remain. The study reveals a number of opportunities to break down remaining barriers to uptake of improved latrines and to further evolve WaterSHED’s market-based approach.

Composting latrine vs. flush toilet: A crowd-funded study

Composting latrine vs. flush toilet: A crowd-funded study | Source: by Rob Goodier, EngineeringForChange, Aug 2014 |

Excerpt: What we know is that composting toilets have clear ecological and economical advantages over flush toilets. They turn waste into compost, and the compost can fertilize crops, completing a circle of nutrients that saves soils and saves money. They save money in the costs of sewage and in fertilizer. Importantly, they also require much less water.

In this composting pit latrine design, when waste has filled the first pit, the latrine is moved over the second pit. The first pit converts to compost and can be emptied to fertilize fields. Credit: E4C Solutions Library

Those arguments for composting latrines are well documented and have been made for years, but how do they compare in hygiene and how do they fare within the cultures of the different people who use them? Do they limit the spread of disease as well as a flush system with a septic tank or a sewer might? And do they feel as comfortable for families to use? Are they as accessible? And are they really the most sustainable solution in global sanitation?

To answer these questions, Jeff Deal the director of health studies at the water and sanitation engineering non-profit Water Missions International, is raising money through the site that crowdfunds scientific research, experiment.com. The goal is $22,000, which Water Missions International will match to pay for the study.

• Read the complete article

Characteristics of latrines in central Tanzania and their relation to fly catches.

Characteristics of latrines in central Tanzania and their relation to fly catches. PLoS One. 2013 Jul 18;8(7).

• Full text

Irish S, Aiemjoy K, Torondel B, Abdelahi F, Ensink JH.

The disposal of human excreta in latrines is an important step in reducing the transmission of diarrhoeal diseases. However, in latrines, flies can access the latrine contents and serve as a mechanical transmitter of diarrhoeal pathogens. Furthermore, the latrine contents can be used as a breeding site for flies, which may further contribute to disease transmission. Latrines do not all produce flies, and there are some which produce only a few, while others can produce thousands. In order to understand the role of the latrine in determining this productivity, a pilot study was conducted, in which fifty latrines were observed in and around Ifakara, Tanzania.

Drop-hole modification and trap placement

The characteristics of the latrine superstructure, use of the latrine, and chemical characteristics of pit latrine contents were compared to the numbers of flies collected in an exit trap placed over the drop hole in the latrine. Absence of a roof was found to have a significant positive association (t=3.17, p=0.003) with the total number of flies collected, and temporary superstructures, particularly as opposed to brick superstructures (z=4.26, p<0.001), and increased total solids in pit latrines (z=2.57, p=0.01) were significantly associated with increased numbers of blowflies leaving the latrine.

The number of larvae per gram was significantly associated with the village from which samples were taken, with the largest difference between two villages outside Ifakara (z=2.12, p=0.03). The effect of latrine superstructure (roof, walls) on fly production may indicate that improvements in latrine construction could result in decreases in fly populations in areas where they transmit diarrhoeal pathogens.

How much does it cost to build a traditional latrine?

A new video by IRC’s WASHCost project examines the full costs of building traditional latrines in Mozambique.

Cost data is essential for planning by the governments. In Mozambique, this is done by local authorities. There are many challenges in getting the right data. One of them is getting data on sanitation and the investments made by households themselves, in particular when latrines are constructed with local materials.

WASHCost Mozambique managed to calculate the estimated total costs for building a traditional latrine. The cost data shows that families are massively contributing to improving public health. The data also shows that promotion of hygiene and sanitation is really worth the effort.

When there is promotion, families build latrines and spend money on them.

For more on the life-cycle costs of sanitation and hygiene read:

• WASHCost Infosheet 2 – The cost of sustaining sanitation services for 20 years
• WASHCost Infosheet 5 – Hygiene promotion: How effective is it? How much does it cost?
• WASHCost Briefing Note 3 – Applying the life-cycle costs approach to sanitation
• WASHCost Working Paper 3 – Assessing sanitation service levels

For more on sanitation in Mozambique read:

• Assessing sanitation services in rural and peri-urban Mozambique

Why must cheap be so ugly?

Everywhere in the world, even the poorest families try to beautify their houses. Then why are low-cost latrines often so ugly, ask IRC’s Christine Sijbesma and Erick Baetings.

Outside gay paints, inside
grey slab in Bangladesh

Christine: Ever since I have been working in the lower cost end of toilet designs I have wondered why most of them are so ugly. I have worked in rural sanitation in Latin America, Sub-Saharan Africa and South Asia and in urban sanitation in South East Asia since the 1970s. Everywhere I have seen how the poorest families also strive to beautify their living environment. In East Africa families paint decorative bands on huts and rake their yards, in India women make beautiful patterns in the sand in front of their katcha houses with coloured powder, and in Indonesian city kampung families tile their front stoops in gay colours and keep potted plants in tins.

USAID/Afghanistan – Latrine & Sanitation Options Manual

Latrine & Sanitation Options Manual, 2010. USAID/Afghanistan Sustainable Water Supply & Sanitation Project. 

• Download (pdf, 23MB)

OBJECTIVE OF THIS MANUAL

Poor sanitation is endemic across Afghanistan and exacts a heavy toll on public health. In response, the Ministry of Rural Rehabilitation and Development (MRRD), multiple donors, the United Nations, several implementers, and USAID are engaged in providing funding and technical leadership to sanitation programs and facility construction throughout the country. These resources are sorely needed, but money and technologies alone cannot solve the problem. Donors and implementers must agree to promote, and uniformly apply sound social development, public health, marketing, finance, and technical guidance to the health-focused planning of new investments and the delivery of sustainable sanitation services.

This Manual aims to meet these needs by serving as a practical guide for Component 2 of USAID‘s Sustainable Water Supply and Sanitation Project (SWSS) and the selection of sanitation technology options to satisfy local desires and meet national needs. While this Manual is developed specifically for SWSS, it is hoped that it will be a living document for the professionals and organizations working to address fecal contamination across Afghanistan.

INTENDED USERS OF THIS MANUAL
This Manual has been written for both engineering and non-engineering field practitioners responsible for the design, construction, and sustainable operation of sanitation programs and facilities. It is primarily intended as a guide for all aspects of SWSS‘ sanitation programs and facility improvements. The Manual is designed to be used by SWSS, its partners from across the United States Government (USG), and its Afghan collaborators to make appropriate choices and engage effectively with engineers working in the field.

13 Loneliest Outhouses on Earth

When you gotta go, you gotta go. And answering nature’s call – any time, anywhere – is certainly what the builders of these remote outhouses seem to have had in mind. Often situated in incredibly scenic locations, some of these outhouses also seem highly precarious, looking like they’re about to topple over a cliff at any minute! Was this positioning chosen in the name of ventilation? Who knows. Regardless, we hope you’ll join us as we marvel at 13 of the loneliest latrines on earth!

What better place for a little outhouse – complete with slanted roof to withstand the elements – than high above the treetops and even over the clouds? If you are interested in visiting, this is the Cougar Peak Lookout in Montana, which overlooks Clark Fork River. Simply breathtaking!

• Link to slideshow

 

Uganda: Teacher falls in pit latrine as he looks for cockroaches

A teacher from St. Mary’s College, Aboke, in northern Uganda fell in a pit latrine as he looked for cockroaches for a biology practical lesson.

Newspaper New Vision reported that the teacher was given money to buy 80 cockroaches for the lesson (from where it doesn’t say), but he decided to pocket the money and look for specimens himself in a pit latrine. He had already collected 40 cockroaches before he fell in. A “good Samaritan” who came to his rescue said it took an hour to pull the teacher out of the latrine.

A eye witness claimed the teacher had drunk some local brew with his colleagues before embarking on his cockroach search.

The teacher sustained minor injuries and was admitted to a clinic in the neighouring district of Lira.

St. Mary’s College in Aboke gained international attention when 139 of its female secondary school students were abducted by rebels of the Lord’s Resistance Army (LRA) on 10 October 1996. The Aboke abductions became one of the most widely known horror stories of the entire conflict.

Source: New Vision, 30 Jul 2011