Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India. Am J Trop Med Hyg. 2015 Jun.
Authors: Heijnen M, Routray P, Torondel B, Clasen T.
A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene.
Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies.
No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
Redefining shared sanitation. WHO Bulletin, July 2015.
Authors: Thilde Rheinländer, Flemming Konradsen, Bernard Keraita, Patrick Apoya, and Margaret Gyapong
The proportion of people depending on shared toilets is higher in the least developed countries (16%) and highest in sub-Saharan Africa, where 19% of the population depends on shared sanitation. In the same region, a staggering 33% of the urban population depends on shared sanitation, and in 17 sub-Saharan countries the rates of people using shared sanitation is on the increase. In four Asian countries, Bangladesh, China, Mongolia and the Philippines, over 15% of the population depend on shared sanitation – a number that increases daily.
Current definitions do not account for the diversity of shared sanitation: all shared toilet facilities are by default classified as unimproved by JMP because of the tendency for shared toilets to be poorly managed and unhygienic. However, we argue that shared sanitation should not be automatically assumed to be unimproved.
Usage and Barriers to Use of Latrines in a Ghanaian Peri-Urban Community. Environmental Processes, March 2015
Authors: Peter A. Obeng, Bernard Keraita, Sampson Oduro-Kwarteng, Henrik Bregnhøj, Robert C. Abaidoo, Esi Awuah, Flemming Konradsen
This study was conducted in a Ghanaian peri-urban setting to understand the factors that influence the usage of household and communal latrines and to discuss potential interventions to address existing barriers to regular usage. Data was collected using household survey questionnaires orally administered to 189 and 283 respondents with access to private and communal latrines respectively, five focus group discussions with gender and age groups, as well as observations at latrines. It was found that only 15 % of households had access to latrines at home while the rest depended on communal latrines or practised open defecation.
The ventilated improved pit latrine was the commonest technology used by 47 % of households with private latrines. The residents ranked safety and privacy as the most important factors that influenced their decision to use any latrine. For private latrines, desludging challenges (14 %) and intense odour (7 %) were the most significant technical barriers while the most significant non-technical barriers were lack of immediate access when the latrine is locked or busy (28 %).
For communal latrines, the major technical barrier was intense odour (23 %) while the major non-technical barriers were distance to latrines (28 %), user fees (21 %) and unhygienic conditions (7 %). Regular latrine usage in the study setting may be enhanced by technical support to address desludging challenges and control odour in latrines, as well as social interventions to make communal latrines affordable and more hygienic.
Is it possible to reach low-income urban dwellers with good-quality sanitation? Env & Urbanization, Apr 2015.
Authors: David Satterthwaite, Diana Mitlin, Sheridan Bartlett
Before public or shared toilets are dismissed as appropriate solutions, is it not worth asking their users what their needs are, what is deficient, what should be done to address this, by whom and with what funding? Where there isn’t universal provision for high-quality sanitation, it is only by engagement with those needing solutions in each location that effective, appropriate solutions will be developed.
The Sanitation Ladder, What Constitutes an Improved Form of Sanitation? Env Sci Tech, Dec 2014.
Authors: Josephine L. R. Exley, Bernard Liseka, Oliver Cumming, and Jeroen H. J Ensink
This study aimed to assess whether the MDG classifications and JMP sanitation ladder corresponded to hygienic proxies. Latrines were purposefully sampled in urban and rural Tanzania. Three hygienic proxies were measured: E. coli on points of hand contact, helminth at point of foot contact, and number of flies. Additionally, samples were collected from comparable surfaces in the household, and a questionnaire on management and use, combined with a visual inspection of the latrine’s design was conducted. In total, 341 latrines were sampled.
The MDG classifications “improved” vs “unimproved” did not describe the observed differences in E. coli concentrations. Disaggregating the data into the JMP sanitation ladder, on average “shared” facilities were the least contaminated: 9.2 vs 17.7 (“improved”) and 137 E. coli/100 mL (“unimproved”) (p = 0.04, p < 0.001). Logistic regression analysis suggests that both the presence of a slab and sharing a facility is protective against faecal-oral exposure (OR 0.18 95% CI 0.10, 0.34 and OR 0.52, 95% CI 0.29, 0.92). The findings do not support the current assumption that shared facilities of an adequate technology should be classified for MDG purposes as “unimproved”.
Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India. Am Jnl Trop Med Hyg, June 2015.
Authors: Marieke Heijnen, Parimita Routray, Belen Torondel and Thomas Clasen
A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination.
Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti. Env & Urbanization, Apr 2015.
Authors: S Tilman.
Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible. This paper presents the results of a pilot household CBS service in Cap Haitien, Haiti. We quantify the excreta generated weekly in a dense urban slum,(1) the proportion safely removed via container-based public and household toilets, and the costs associated with these systems.
The CBS service yielded an approximately 3.5-fold decrease in the unmanaged share of faeces produced, and nearly eliminated the reported use of open defecation and “flying toilets” among service recipients. The costs of this pilot small-scale service were higher than those of large-scale waterborne sewerage, but economies of scale have the potential to reduce CBS costs over time. The paper concludes with a discussion of planning and policy implications of incorporating CBS into the menu of sanitation options for rapidly growing cities.
A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique. BMJ Open 2015;5:e008215 doi:10.1136/bmjopen-2015-008215.
Authors: Joe Brown, Oliver Cumming, Jamie Bartram, et al.
Introduction – Access to safe sanitation in low-income, informal settlements of Sub-Saharan Africa has not significantly improved since 1990. The combination of a high faecal-related disease burden and inadequate infrastructure suggests that investment in expanding sanitation access in densely populated urban slums can yield important public health gains. No rigorous, controlled intervention studies have evaluated the health effects of decentralised (non-sewerage) sanitation in an informal urban setting, despite the role that such technologies will likely play in scaling up access.
Methods and analysis – We have designed a controlled, before-and-after (CBA) trial to estimate the health impacts of an urban sanitation intervention in informal neighbourhoods of Maputo, Mozambique, including an assessment of whether exposures and health outcomes vary by localised population density. The intervention consists of private pour-flush latrines (to septic tank) shared by multiple households in compounds or household clusters. We will measure objective health outcomes in approximately 760 children (380 children with household access to interventions, 380 matched controls using existing shared private latrines in poor sanitary conditions), at 2 time points: immediately before the intervention and at follow-up after 12 months. The primary outcome is combined prevalence of selected enteric infections among children under 5 years of age. Secondary outcome measures include soil-transmitted helminth (STH) reinfection in children following baseline deworming and prevalence of reported diarrhoeal disease. We will use exposure assessment, faecal source tracking, and microbial transmission modelling to examine whether and how routes of exposure for diarrhoeagenic pathogens and STHs change following introduction of effective sanitation.
WSUP – The MAPSAN Trial: A Controlled Before and After Study of Shared Sanitation in Maputo, 2015.
This major study, funded by USAID, is being led by the London School of Hygiene and Tropical Medicine (LSHTM). The research is looking at a number of related questions: will this communal toilet intervention have an effect on health, and more specifically, will any effects be dependent on population density? (We would expect the positive effect on health to be stronger in areas with higher population density)
It’s a fascinating and innovative study in many respects, not least because of the wide range of health metrics being measured: not just self-reported diarrhoea incidence (the common measure, widely suspected to be unreliable), but also a bunch of other metrics including child height and weight, parasites in child stools, and biochemical markers of viral and parasite infection. Plus at the same time other researchers will be applying the Gates-supported SaniPath approach to get a measure of degree of faecal contamination of the local environment.
Sites of entitlement: claim, negotiation and struggle in Mumbai. Environment and Urbanization, 2015.
Authors: Colin McFarlane, Renu Desai
This paper develops a conception of “sites of entitlement” as a basis for better understanding how infrastructure and services are perceived and experienced in informal settlements. While legal and policy frameworks are often viewed as the source of entitlements to infrastructure and services, the complexity of provision, access and negotiation in informal settlements demands a conception of entitlement that exceeds those domains. Based on ethnographic research on sanitation and water in informal settlements in Mumbai, we focus on the ways in which people’s everyday experiences, interactions and practices constitute sites of entitlement.
These sites are unevenly produced, contested, often in flux and ambivalent, sometimes made through collective struggle and at other times through quiet individual practice, and always constituted by social relations. Sites of entitlement emerge in close relation to moral economies, and are characterized by often profound and – for research, policy and practice – challenging levels of spatial and temporal variation. We argue that sites of entitlement are vital for thinking through the possibilities of realizing the universal right to sanitation and water.
