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A study was carried out to assess the quality of groundwater and its suitability for domestic use in Ushewokunze peri-urban Settlement, Harare, Zimbabwe. The study area is not yet serviced with water supply and sanitation. This leaves residents solely dependent on pit latrines for sanitation and on groundwater sources for potable water supply. Ushewokunze is divided into Phase 1; with residential stand sizes of 1 500 m2 - 2000 m2; Phase 2 where stand sizes are from 150 m2 to 250 m2 and Phase 3 where residential stands are of approximately 500 m2 sizes. Seventeen hand-dug shallow wells and the only three existing boreholes in Ushewokunze were selected for sampling. Eighty groundwater samples were collected monthly from January to April 2017, and were analysed, by standards methods, for parameters which included turbidity, Electrical Conductivity, Dissolved Oxygen, chlorides, nitrates, phosphates and faecal coliforms. A water quality index (WQI) was determined. A one sample t-test was performed in SPSS software (v23) at 95% confidence interval, to determine the suitability of the groundwater for drinking purposes. This was done by comparing the mean values of the analysed groundwater parameters with WHO (2011) guidelines and SAZ 560:1997 standards. Spatial variability maps of the measured parameters were prepared by applying the inverse distance weighting method of spatial interpolation with ILWIS 3.3. The obtained results for the means were 6.6 ± 0.33, 10.8 ± 8.4 NTU, 68.7 ± 27 mg/L, 908.6 ± 424 μs/cm, 5.61 ± 1.6 mg/L, 72.07 ± 36 mg/L, 1.14 ± 0.06 mg/L and 77 ± 36 CFU/100 mL for pH, turbidity, chloride, EC, DO, nitrates, phosphates and faecal coliforms, respectively. The Student t-test showed significant differences (p

(IF 5.59 [2018]; Q1); International audience; Sub-Saharan urban centers have to tackle high population growth, lack of sanitation infrastructures and the need for good quality water resources. To characterize the impacts of anthropization on the water resources of the capital of Cameroon (Yaoundé), a multi-disciplinary approach was used in ten sub-watersheds (peri-urban and urban) of the Méfou watershed. Pharmaceutical residues were used as tracers of surface and groundwater contamination caused by the release of domestic wastewater from pit latrines and landfills. A water use survey was conducted in the vicinity of the sampling sites to better assess water use, treatment and management. Available land use and hydro-geomorphological data completed characterization of the sub-watersheds. The combined data showed that natural features (elevation, slope, and hydrography) and human activities (land use) favor rainfall-runoff events and hence surface water contamination. Pharmaceutical monitoring revealed contamination of both surface and groundwater especially in the urban sub-watersheds. Analgesics/anti-inflammatory drugs and anti-epileptic carbamazepine were the most frequently found compounds (in up to 91% of water samples) with concentrations of acetaminophen reaching 5660 ng/L. In urban sub-watersheds, 50% of the groundwater sites used for drinking water were contaminated by diclofenac (476–518 ng/L), carbamazepine (263–335 ng/L), ibuprofen (141–276 ng/L), sulfamethoxazole (

Objective To describe women's experiences with subcutaneous depot medroxyprogesterone acetate (DMPA-SC) to inform scale-up of self-administered DMPA-SC. Study design We conducted a 12-month randomized controlled trial in Malawi to measure DMPA-SC continuation rates. A total of 731 women presenting at six Ministry of Health clinics or to community health workers (CHWs) in rural communities were randomized to receive DMPA-SC administered by a provider or be trained to self-inject DMPA-SC. Data collectors contacted women after the reinjection window at 3, 6 and 9 months to collect data on satisfaction and use; self-injectors were also queried about storage and disposal of DMPA-SC. We compared frequencies of injection experiences and satisfaction by study group and over time. Results Ninety-two percent of women who self-injected felt it was easy to do the first time. Women in the self-administered group primarily gave themselves the injection versus having someone else inject them; stored DMPA-SC mostly in bags, often in ways to keep the product away from others; and properly disposed of DMPA-SC in pit latrines. Women in both groups used printed calendars to remember when to get/be given their next injection. Both groups reported high satisfaction with DMPA-SC. Conclusions Women in low-resource settings can be successfully trained by public sector CHWs and clinic-based providers to self-inject and to appropriately store and dispose of DMPA-SC. DMPA-SC and self-injection are acceptable and feasible in a low-resource setting. Implications Self-administered and provider-administrated DMPA-SC should be scaled up, and the lessons learned during our trial should be applied to future scale-up efforts.

Only a small proportion of Addis Ababa is served by conventional sewerage treatment systems. Most of the city relies upon on-site sanitation, while open defecation remains a common practice, especially in slum areas. This paper provides evidence of environmental pollution related to inadequate sanitation using a range of physicochemical and fecal contamination indicators and a mix of surveys of pit latrine contents, soils and water sources. Some water sources, including deep wells, show indications of fecal contamination, and soils are widely contaminated with the parasitic worm, Ascaris lumbricoides. Analysis of pit latrine contents shows a significant reduction in the number of A. lumbricoides ova with depth, but levels of ova at even the bottom of the pit suggest the need for proper sludge treatment. Wider awareness of environmental pollution gleaned from this research is intended to inform policy makers and their prioritization of actions to improve urban sanitation.

Parallel global rise in pit-latrine sanitation and groundwater-supply provision is of concern due to the frequent spatial proximity of these activities. Study of such an area in Malawi has allowed understanding of risks posed to groundwater from the recent implementation of a typical developing-country pit-latrine sanitation policy to be gained. This has assisted the development of a risk-assessment framework approach pragmatic to regulatory-practitioner management of this issue. The framework involves water-supply and pit-latrine mapping, monitoring of key groundwater contamination indicators and surveys of possible environmental site-condition factors and culminates in an integrated statistical evaluation of these datasets to identify the significant factors controlling risks posed. Our approach usefully establishes groundwater-quality baseline conditions of a potentially emergent issue for the study area. Such baselines are foundational to future trend discernment and contaminant natural attenuation verification critical to policies globally. Attribution of borehole contamination to pit-latrine loading should involve, as illustrated, the use of the range of contamination (chemical, microbiological) tracers available recognising none are ideal and several radial and capture-zone metrics that together may provide a weight of evidence. Elevated, albeit low-concentration, nitrate correlated with some radial metrics and was tentatively suggestive of emerging latrine influences. Longer term monitoring is, however, necessary to verify that the commonly observed latrine-borehole separation distances (29–58 m), alongside statutory guidelines, do not constitute significant risk. Borehole contamination was limited and correlation with various environmental-site condition factors also limited. This was potentially ascribed to effectiveness of attenuation to date, monitoring of an emergent problem yet to manifest, or else contamination from other sources. High borehole usage and protective wall absence correlated with observed microbiological contamination incidence, but could relate to increased human/animal activity close to these poorly protected boreholes. Additional to factors assessed, a groundwater-vulnerability factor is recommended that critically relies upon improved proactive securing of underpinning data during borehole/latrine installations. On-going concerns are wide ranging, including poorly constrained pit-latrine input, difficulties in assessing in-situ plume natural attenuation and possible disposal of used motor oils to latrines.

The ongoing Toilet Revolution in China offers an opportunity to improve sanitation in rural areas by introducing new approaches, such as urine source separation, that can contribute to achieving SDG6. However, few studies have systematically assessed the social acceptability of managing human excreta collected in new sanitation systems. Therefore, in this study we performed face-to-face interviews with 414 local residents from 13 villages across three provinces in western China, to analyze the current situation and attitudes to possible changes in the rural sanitation service chain. We found that the sanitation chain was predominantly pit latrine-based, with 86.2% of households surveyed collecting their excreta in a simple pit, 82% manually emptying their pits, and 80.2% reusing excreta in agriculture without adequate pre-treatment. A majority (72%) of the households had a generally positive attitude to production of human excreta-derived fertilizer, but only 24% agreed that urine and feces should be collected separately. Multivariate logistic regression indicated that three factors (level of education, number of permanent household residents, perceived social acceptability) significantly influenced respondents' attitudes to reuse of excreta, although only perceived social acceptability had a high strength of association. Overall, our survey revealed that rural households often misuse toilet systems, fail to comply with government-specified sanitation guidelines, have low awareness of alternative solutions, and are over-reliant on the government to fix problems in the service chain. Thus while new sanitation technologies should be developed and implemented, information campaigns that encourage rural households to manage their excreta safely are also important., Graphical abstract Unlabelled Image, Highlights • Face-to-face interviews were performed at 414 rural households in western China. • Both status and attitude towards the rural sanitation service chain were evaluated. • Poor hygiene practices are ubiquitous across the service chain, posing health risk. • Perceived social acceptability correlated with positive attitude to excreta reuse. • Awareness campaigns can positively influence sanitation management.

In unplanned urban settlements, where onsite sanitation systems are the norm, desludging of faecal sludge (FS) containments is a necessity because of the lack of land space to enable new construction. Poorly designed toilet facilities however may jeopardize the progress towards attainment of safely managed sanitation. This study examined FS characteristics and containment design and their effect on safe desludging with a case of two selected unplanned settlements of Dar es Salaam, Tanzania. The analysis focused on design features for the strength of the containment, access to the containment, and desludging characteristics of the FS. The Desludgeability potential of FS was determined on basis of flow behaviour explained in terms of moisture content and volatile solids. Research results showed that partially lined pits, lack of containment access holes and solid wastes are design and usage features which negatively affect containment strength and potential for safe desludging. The analysis further found that, only 54.8% of containments studied have FS that can be desludged by either mechanized or hand pumps. Pour flush toilets and septic tanks indicated a slightly higher potential for safe desludging compared to traditional pit latrines, however, the difference is not statistically significant (P = 0.180). Thus, safe desludging is a problem across all types of containments. To enhance safe desludging in Dar es Salaam, three key design features and usage ought to be urgently addressed: first, a requirement to ensure that all pits are fully lined inside, second, the mandatory presence of an access hole for FS desludging and third, limitations on solid waste entering the pits.

The importance of access to safe drinking water and improved sanitation facilities have by and large driven the global water, sanitation and hygiene agenda. However, a large segment of the global population, particularly in developing countries remain without access. Botswana has made significant strides towards improving access to safe drinking water and improved sanitation, but there have been observations in certain low-income neighbourhoods in Gaborone and Francistown that some households lacked access to such services. Furthermore, the coping strategies used by households to mitigate lack of access to drinking water and sanitation services were unclear. This study established barriers to household accessing drinking water and waterborne sanitation in urban neighbourhoods of Botswana and determined coping strategies employed by households without access. It is a cross-sectional survey of two neighbourhoods of Old Naledi (Gaborone) and Monarch North (Francistown). A semi-structured questionnaire was used to interview household respondents that were purposively selected. It was found that land tenure with its different manifestations is the primary barrier to access to safe drinking water and waterborne sanitation services. Households who lacked access to drinking water mainly fetched water from their neighbours and contributed to the water bill, while those without access to waterborne sanitation used pit latrines as their sanitation option. The study recommends that in order to facilitate drinking water and waterborne sanitation access it is important that the socio-economic conditions of potential beneficiaries are understood at a low level of aggregation such as a household to enable household-specific policy interventions.

Classifications for onsite sanitation in terms of facility type (septic tanks, pit latrines) exist, but connecting these facilities to the wider sanitation value chain via improved containment, emptying, and collection has not been well explored. Using existing Joint Monitoring Programme facility classifications and secondary data on piped water access, a Service Typology was developed to classify and quantify the primary emptying service needs of household level onsite sanitation facilities. Facilities in six Sustainable Development Goal (SDG) regions were classified as Emptiable (faecal sludge can be removed either via Mechanized or Non-Mechanized means) or Unemptiable. Of the 722 million household level sanitation facilities assessed in these regions, 32% were found to be emptiable via Mechanized means, 50% via Non-Mechanized means and 18% were found to be Unemptiable pits. The volume (by number of facilities) and density (as a proportion of the full population) of each service type were estimated by SDG region and by country. Results from this study provide background data on the role of emptying sanitation facilities in achieving SDG6, and can be incorporated into investment priorities, policy framing, technology development, infrastructure development, and targeted behaviour change strategies., Graphical abstract Image 1, Highlights • First study to quantify the service needs for 772 M onsite sanitation facilities. • 32% of facilities are emptied via Mechanized means using pumps or vacuum trucks. • 50% of facilities are manually emptied via Non-Mechanized means. • 18% of facilities are unimproved and Unemptiable due to their poor quality. • Service innovation for dry, improved onsite facilities identified as priority need.

Faecal contamination of groundwater from pit latrines is widely perceived as a major threat to the safety of drinking water for several billion people in rural and peri-urban areas worldwide. On the floodplains of the Ganges-Brahmaputra-Meghna delta in Bangladesh, we constructed latrines and monitored piezometer nests monthly for two years. We detected faecal coliforms (FC) in 3.3-23.3% of samples at four sites. We differentiate a near-field, characterised by high concentrations and frequent, persistent and contiguous contamination in all directions, and a far-field characterised by rare, impersistent, discontinuous low-level detections in variable directions. Far-field FC concentrations at four sites exceeded 0 and 10 cfu/100 ml in 2.4-9.6% and 0.2-2.3% of sampling events respectively. The lesser contamination of in-situ groundwater compared to water at the point-of-collection from domestic wells, which itself is less contaminated than at the point-of-consumption, demonstrates the importance of recontamination in the well-pump system. We present a conceptual model comprising four sub-pathways: the latrine-aquifer interface (near-field); groundwater flowing from latrine to well (far-field); the well-pump system; and post-collection handling and storage. Applying a hypothetical dose-response model suggests that 1-2% of the diarrhoeal disease burden from drinking water is derived from the aquifer, 29% from the well-pump system, and 70% from post-collection handling. The important implications are (i) that leakage from pit latrines is a minor contributor to faecal contamination of drinking water in alluvial-deltaic terrains; (ii) fears of increased groundwater pollution should not constrain expanding latrine coverage, and (iii) that more attention should be given to reducing contamination around the well-head.

Due to the frequent use of antibiotics and recurring illnesses related to multidrug-resistant (MDR) bacteria in South Africa, we determined if MDR Escherichia coli were present in pit latrine fecal sludge samples obtained from a peri-urban community in KwaZulu-Natal, South Africa. The abundance of E. coli in pit latrine samples was established using a most probable number (MPN) method with species confirmation done using biochemical tests and polymerase chain reaction (PCR). Forty-four randomly selected E. coli pit latrine isolates were further characterized, using the European committee on antimicrobial susceptibility testing (EUCAST) disk diffusion method to establish antibiotic resistance profiles for these E. coli isolates. The resulting MPN values for E. coli ranged from one to 6.2 log10 MPN per gram of fresh pit latrine fecal sludge. While only 3 out of 44 E. coli pit latrine isolates showed no resistance to any of the 12 tested antibiotics, most isolates were resistant to two or more antibiotics. The majority of isolates showed resistance to at least one of the two tested aminoglycosides, one isolate showed resistance to the carbapenem ertapenem, and although resistance was not detected for tigecycline four pit latrine E. coli isolates showed intermediate resistance to this antibiotic. However, about 14% of the E. coli pit latrine isolates were categorized as MDR, all of which showed resistance to four or more antibiotics. The presence of MDR E. coli strains in pit latrine samples demonstrates that these facilities are potential sources for MDR bacteria.

In order to create sustainable systems for resource management, residues from cooking and ecological sanitation (EcoSan) can be employed in recycling-driven soil fertility management. However, the link between energy, sanitation, and agricultural productivity is often neglected. Hence, the potential self-sufficient nature of many smallholdings in sub-Saharan Africa is underexploited. Objective To compare those cooking and sanitation technologies most commonly used in north-western Tanzania with locally developed alternatives, with respect to (i) resource consumption, (ii) potential to recover resources, and (iii) environmental emissions. This study examines technologies at the household level, and was carried out using material flow analysis (MFA). The specific bioenergy technologies analysed include: three-stone fires; charcoal burners; improved cooking stoves (ICS), such as rocket and microgasifier stoves; and biogas systems. The specific sanitation alternatives studied comprise: pit latrines; two approaches to EcoSan; and septic systems. Results The use of ICS reduces total resource consumption; using charcoal or biogas does not. The residues from microgasifiers were analysed as having a substantial recovery potential for carbon (C) and phosphorus (P). The fact that input substrates for biogas digesters are post-agricultural in nature means that biogas slurry is not considered an ‘untapped resource’ despite its ample nutrient content. Exchanging pit latrines for water-based sanitation systems places heavy pressure on already scarce water resources for local smallholders. In contrast, the implementation of waterless EcoSan facilities significantly promotes nutrient recovery and reduces environmental emissions, particularly through greenhouse gas emission and nutrient leaching. Conclusions Recycled outputs from the triple energy-sanitation-agriculture nexus display complementary benefits: residues from cooking can be used to restore organic matter in soils, while sanitation residues contribute to fertilisation. The combination of microgasifiers and EcoSan-facilities is the most appropriate in order to simultaneously optimise resource consumption, reduce environmental impacts, and maximise recycling-based soil management in smallholder farming systems.

This study, conducted in 40 selected upazilas covering four hydrological regions of Bangladesh, aimed at determining the risk of selected shallow tubewells (depth

Objectives Currently few children with tracheostomies attend rural mainstreams schools in South Africa limiting their ability to gain an education. We sought to document the current school experience for the few children attending school who have tracheostomies and devise educational tools for teachers and administrators that will facilitate greater acceptance and safety in classrooms for this population. Methods The four patients that are currently attending school with a tracheostomy were identified from the patient records of a tertiary hospital with a pediatric tracheostomy home based care service. With the aid of a Zulu language translator, the mothers and classroom teachers completed a semi structured interview and closed item questionnaire in their home and school, respectively. Schools were visited to understand and describe the settings in which the children and their teachers were being asked to function. Tools for education were developed in conjunction with key stakeholders at schools already hosting such children. Results The key teacher-identified barriers to enrollment were: teacher unfamiliarity with tracheostomies, uncertainty about the school's liability, and concerns about the response of other children. The safety barriers identified were: greater than 60 children per classroom - limiting teacher's ability to attend to the child with a tracheostomy, lack of running water, pit latrines separate from school threatening hygiene and isolating the child when they leave to use the latrines & sandy classrooms which can result in sand entering the airway. Identified needs for successful school placement include providing tracheostomy supplies and suctioning equipment, hand hygiene materials and training teachers in: identification of respiratory distress, performance of emergency tracheostomy changes, CPR. Conclusions Children with tracheostomies could likely successfully attend South African rural mainstream public schools with a training program for teachers. As a first step, an introductory booklet for teachers that explains tracheostomies and provides educational and safety suggestions was created. A list of recommendations for successful inclusion of students in the school system was developed together with and delivered to key stakeholders.

Background: The polarization of the Nigerian society with a population of about 198 million people, growing at the rate of 3.2% per annum, into a large rural sector and a small urban component provides a basis for the inadequate provision of health infrastructure in the rural areas. For instance, over 65% of Nigerian population who live in the rural areas are most neglected and deprived of basic services as well as other modern infrastructural necessities that are essential to the maintenance and promotion of good health. Hence its supply is a major factor for consideration in the health of any community. This study aimed to assess the sources of water supply, sanitation facilities and hygiene practices in an island community of Amassoma, Bayelsa State. Materials and Method: A cross sectional descriptive study design was used, the 357-sample size for housing units was determined using the appropriate statistical formula and systematic sampling method was used with a sampling interval of two. A 30-item administered closed-ended structured questionnaire was used. Data was collected from 198 households and analysed using descriptive statistics with frequency counts and simple percentages using computer aided statistical analysis by Microsoft Excel. Results: The result identified multiple sources of water supply which includes rain, river/stream, pipe borne, borehole, sachet water and table water with borehole and sachet water being the major source. The sanitary condition of the water source shows that 28.8% dirty, 5.6% fairly clean, 68.7% admitted to not treating their water at home, while 15.2% just store at home, 10.1% use water guard and 6.0% practice boiling. For the toilet facilities, 40.9% use septic tank, 33.8% do open defecation, 15.7% use the river, 13.1% use traditional pit latrines, while 9.0% use ventilated improved toilet pit latrine. 5.6% were fairly clean, 28.8% dirty while 39.4% use the river for bathing purposes, 14.1% have open bathrooms while 1.6% have other forms of bathroom facilities. 63.6% dump their refuses at open dump sites while 10.6% burn theirs. 9.9% dump refuses in the river while 22.2% practice other forms of refuse disposal. Hand washing, an important hygiene practice with 95.9% practicing hand washing after visiting the toilet, 76.8% before cooking, 72.7% after cooking while 85.9% before eating. Common health problems show, 25.3% of the respondents had malaria, 20.7% diarrhoea, 9.1% skin rash, while 2.0% had cough. About 31.8% of them attributed poor sanitation as a causal factor, 23.2% of the respondents associated water as a possible causal factor, while 44.9% did not attribute their health challenges to any causal factor. 52.0% purchase drugs from patent drug stores for treatment, 36.9% visit hospitals, while 11.1% patronize traditional doctors. Conclusion: Sanitation facilities and safe water supply are insufficient in Amassoma community. This along with hygienic practices led to the prevalence of common illnesses in the community. Poor sanitation and unhygienic practices are still widely practiced. The State and Local Government should provide adequate portable water and sanitation facilities in public places with emphasis on citizen advocacy in the area of health education campaign.

Blantyre, Malawi has approximately one million people who rely on pit latrines for sanitation and yet there is a limited pit-emptying sector to empty, transport and safely discharge the faecal sludge. Over three years, we monitored the volume of sludge that was safely discharged at the authorized Wastewater Treatment Plants (WWTP) and in parallel, estimated the volume of sludge that is currently buried within pit latrines of Blantyre, based on measurements at 321 households. Comparing the volumes of sludge emptied to the volumes of sludge buried, we highlight the fact that a) there is a suspiciously low volume of pit-derived faecal sludge being safely disposed; b) most safely discharged sludge is taken from the small proportion of septic tanks in the city, and not from pit latrines; and c) that the cost of safely discharging does not seem to correlate with the volumes delivered (despite an option to discharge for free). There is a large and growing amount of sludge buried beneath the city which will need to be safely emptied and treated in coming years. The city and the WWTPs must move quickly to ensure that the businesses and infrastructure are prepared for the future faecal sludge management challenges that lay ahead, especially if they are to achieve SDG 6 by 2030.

Emerging organic contaminants have not received a lot of attention in developing countries, particularly Africa, although problems regarding water quantity and quality are often even more severe than in more developed regions. This study presents general water quality parameters as well as unique data on concentrations and loads of 24 pharmaceuticals including antibiotic, anti(retro)viral, analgesic, anti-inflammatory and psychiatric drugs in three wastewater treatment plants, three rivers and three groundwater wells in Nairobi and Kisumu. This allowed studying removal efficiencies in wastewater treatment, identifying important sources of pharmaceutical pollution and distinguishing dilution effects from natural attenuation in rivers. In general, antiretrovirals and antibiotics, being important in the treatment of common African diseases such as HIV and malaria, were in all matrices more prevalent as compared to the Western world. Wastewater stabilization ponds removed pharmaceuticals with an efficiency between 11 and 99%. Despite this large range, a different removal is observed for a number of compounds, as compared to more conventional activated sludge systems. Total concentrations in river water (up to 320 μg L(-1)) were similar or exceeded concentrations in untreated wastewater, with domestic discharges from slums, wastewater treatment plant effluent and waste dumpsites identified as important sources. In shallow wells situated next to pit latrines and used for drinking water, the recalcitrant antiretroviral nevirapine was measured at concentrations as high as 1-2 μg L(-1). Overall, distinct pharmaceutical contamination patterns as compared to the Western world can be concluded, which might be a trigger for further research in developing regions.

Ground water is an important source of water to any economy. However, ground water can be vulnerable to a series of factors and activities both on and within the surface of the earth. This study explored the vulnerability of the groundwater to pollution in the Ga-Sengonyana municipality area of the Northern Cape Province. The study adopted an exploratory research design that includes both quantitative and qualitative research approaches. The groundwater vulnerability assessment conducted using the DRASTIC index revealed a DRASTIC score of 140, implying that there is moderate to high vulnerability of aquifers in the Ga-Sengonyana district municipality. Both natural and anthropegenic factors contribute to ground water pollution in the study area. The unconsolidated material of sand, embedded dolomite and limestone that forms the vadose zone (unsaturated zone) and aquifer media contributed to high vulnerability of underground water to pollutants. The aquifer in the municipality area is highly vulnerable to both point and diffuse source of pollutants emanating from different land-use systems. It is therefore necessary for disaster management agencies and local municipality authorities to plan carefully on different land-uses and eliminate activities that provides the source of pollutants such as pit latrines and sewage leakages.

The importance of faecal sludge management is gaining recognition. However, methods are still lacking to reasonably estimate the quantities and qualities (Q&Q) that need to be managed, which makes the planning for and implementing of management solutions quite difficult. The objective of this study was to collect and analyse Q&Q of faecal sludge at a citywide scale, and to evaluate whether "SPA-DET" data (=> spatially analysable - demographic, environmental and technical) could then be used as predictors of Q&Q of faecal sludge. 60 field samples and questionnaires from Hanoi and 180 from Kampala were analysed. Software tools were used in an iterative process to predict total solids (TS) and emptying frequency in both Hanoi, Vietnam and Kampala, Uganda. City-specific data could be predicted with types of "SPA-DET" data as input variables, and model performance was improved by analysing septic tanks and pit latrines separately. Individual models were built for TS concentrations and emptying frequency. In addition, a model was built across both cities for emptying frequency of septic tanks based on number of users and containment volume, indicating predictive models can be relevant for multiple cities. Number of users, containment volume, truck volume and income level were identified as the most common variables for the correction function. Results confirm the high intrinsic variability of faecal sludge characteristics, and illustrate the importance of moving beyond simple reporting of city-wide average values for estimations of Q&Q. The collected data and developed scripts have been made available for replication in future studies.

In the rural healthcare setting of low-income countries, water may be used for patients taking medication or general consumption; general clinic cleaning; handwashing for staff, patients and visitors; and dilution of chlorine solutions for disinfection. Accessible toilets and adequate supplies of soap for handwashing are also needed. The focus of this research was to explore access to water, sanitation and hygiene in rural, government front-line-village health clinics in Ntcheu District, Malawi. The study collected data from 81 clinics using an observational checklist and interviews with clinic personnel. Nearly all clinics (80/81; 99%) reported having a year-round water source. Only 11% of clinics (9/81) had water and soap for handwashing. While all clinics were observed to have pit latrines for patients, staff and visitors, only 42% (34/81) of clinics would be categorized as having improved sanitation facilities, including having a drop-hole cover, roof and privacy, but not necessarily separate facilities for staff and patients or visitors. Furthermore, pit latrines in this study could not be safely emptied, with human excreta mixed with medical waste, and poor latrine-construction standards. The results of this study demonstrate the need for understanding front-line health services offered at a permanent or semipermanent shelter, within the household of the provider, or in an open space, compared to larger healthcare facilities. While this study found that rural village health clinics generally had adequate coverage of water and sanitation, and better access than reported nationwide in rural households or schools, handwashing facilities remain an important gap to be filled.

Poor environmental technologies and gastrointestinal illnesses have been hypothesized to be a primary cause to the lack of impact of child health programs on child stunting rates (low height-for-age) in South Africa. This study assessed correlations between environmental exposures (water source, water treatment, sanitation, refuse), diarrheal occurrences, and systemic inflammation proxies among female and male children under five years of age in the Eastern Cape. A conceptual model was hypothesized using structural equation (SE) modeling and two sex-specific (female and male) datasets were subsequently generated from the data and applied to the hypothesized SE model. Results suggested that environmental exposure variables associated with diarrhea and systemic inflammation proxies were different between females and males. For diarrheal occurrences among females, an increase in local authority management of refuse (compared to household management) (0.161, p-value (p) = 0.007), sharing sanitation facilities (0.060, p = 0.023), and a decrease in the frequency of the treatment of drinking water (−0.043, p = 0.025) were correlated with an increase in diarrhea. For males, an increase in household use of flush toilets (as compared to ventilated pit latrines) was correlated with an increase in diarrhea (0.113, p = 0.027). For systemic inflammation among both sexes, an increase in household use of water pumped into the premises (as compared to a public water tap) and an increase in diarrheal occurrences were correlated with an increase in systemic inflammation. The data support an increased focus on sex and gender specific factors among field practitioners and policy makers working in the environmental health field in South Africa.

Over one billion of the poorest people on earth continue to practice open defecation. A complex assemblage of factors, embedded within prevailing inequities and inequalities, continue to betray efforts to improve this. Subsidy-based projects have had little impact in rural Africa where sanitation remains under-prioritised by the state and donors. Community-led total sanitation (CLTS) offers a new, people-centric approach conceptually grounded in participatory development. But despite its broad appeal, the CLTS policy narrative has become equated with quick results, low-cost, provocative language and the potential for community self-help. Drawing on research in Katete district, Eastern Zambia, this paper explores tensions between CLTS theory, policy, practice and local realities. Rapidly scaled-up by local government, poor management and stakeholder engagement effectively diluted the approach, and continued the “projectification” of the sanitation sector. Open defecation, both symbolically and practically, represented an embedded marginalisation from the modern Zambian state where multiple barriers to latrine construction coexisted in the context of fragile livelihoods. In such agrarian communities, CLTS cannot be conceptualised as a blanket approach quickly bringing total sanitation to the masses. For its strengths to be realised in contexts of rural poverty, a targeted strategy that builds local institutional capacity and iteratively scales-up over time is needed. But realising this in practice requires moving beyond a prevailing emphasis on “open defecators” to engage complex issues of power and politics in sanitation governance.

In many urban poor areas of Sub-Saharan Africa (SSA), demand for human excreta disposal is met, predominantly by pit latrines. This study aimed at determining the status of pit latrines (design, construction, operation and maintenance) and its influence on latrine performance (filling, smell and insect nuisance). The study was conducted on 130 pit latrines in typical urban poor areas of Kampala, Uganda. Data on design, construction, usage, operation and performance of the pit latrines was collected by interviews, observations and measurements; and analysed by descriptive statistics, bi-variate analysis and logistic regression. Results showed that the level of pit content was predicted by rain or storm water entry, terrain, cleaning before or after use and number of households using the latrine. Smell was predicted by cleanliness, stance length, superstructure material and whether the latrine was private or public. The predictor of presence of flies was the superstructure material. To improve the performance of pit latrines in urban poor areas, researchers and practitioners should develop local latrine design standards (dimensions, construction materials and number of users) and cleaning guidelines for local policy makers to implement.

Pit Latrines and Septic tanks are common modes of onsite sanitation commonly used in India. These modes of onsite sanitation are becoming source of Groundwater contamination. The chemical contaminants and pathogenic bacteria released from these onsite sanitation systems are in filtered into the surrounding groundwater sources through soil media and causing the threat. This threat is more severe in dense habitation where both onsite sanitation and drinking water resources are spaced very close. In the present study Field investigations are carried out in peri urban areas having different geological settings in Bangalore Rural district and Ramanagara district. Water and soil samples are collected during all seasons of a year near onsite sanitation system and analyzed for critical pollution parameters. The analysis of results reveals that concentrations of critical parameters exceeding the permissible limits of drinking water quality.

Current burdens of faecally derived pathogens entering the environment through untreated human and animal faeces can lead to disease, through direct handling and through contamination of water supplies used for drinking and washing. Anaerobic digestion for biogas generation in rural households in Sub-Saharan Africa has the potential to reduce pathogen loadings to the environment through treatment of livestock manures and effluent from pit latrines. However, there are limited data available for its efficacy in Sub-Saharan Africa. We review evidence from around the world and consider its application to the Sub-Saharan African situation.

The present scoping study seeks to address the sources of water, sanitation, and hygiene (WASH) exposure of residents of peri-urban Ger areas of Ulaanbaatar, Mongolia. Field observations and semi-structured key informant interviews were carried out during 2012 and 2013 to assess the existing WASH situation in the peri-urban Ger areas of Ulaanbaatar, Mongolia. In addition, a knowledge, attitude, and practice (KAP) survey was conducted by Action Contre la Faim (ACF) Mongolia in 210 households to identify the sources of WASH-borne hazards in a statistically representative way. Moreover, the quality of drinking water was analyzed both at the household ( n = 210) and water point (kiosk) ( n = 40) levels to assess the risk of chemical and pathogenic contaminants. Both field observations and interviews revealed that the sanitary environment of the Ger residents is characterized by the lack of a drainage system, unimproved sanitation technology (e.g. unhygienic pit latrines and soak pits), unsafe water supply, and insufficient collection, transportation, and storage mechanisms. Poor infrastructure is associated with low standards of living. The transmission of WASH-borne disease (e.g. diarrhea, dysentery, hepatitis A) is the gravest consequence and source of hazards. The results from the water quality analysis demonstrate that Ger residents are more exposed to biological contamination of stored drinking water by Escherichia coli during the summer (May to August) than in the winter (November to February). During the winter, 36% of household storage containers were contaminated by E. coli at an average level of 12.5 E. coli per 100 ml, while, during the summer, 56% of household storage containers were contaminated at an average level of 50 E. coli per 100 ml. KAP surveys further reveal that the common practice of Ger residents to discharge greywater (with higher chemical oxygen demand) into pit latrines, soak-pits, yards, and streets likely causes environmental pollution and health hazards. Multifaceted WASH-borne exposure was addressed by the scoping study such that various WASH interventions could be planned for the study area and beyond. To tackle the above challenges and problems, a range of appropriate interventions and programs are recommended to reduce the exposure of WASH-borne hazards in the study area and other parts of the world – in both urban and peri-urban settings. The recommendations include: the development and implementation of a water safety plan (WSP), an effective monitoring system for collection, transportation and storage at both water kiosk and household levels, user training for correct use of water containers, effective coordination among stakeholders (including urban planners), development of a household greywater disposal system, and implementation of a functioning solid waste management system. Prior to taking these actions, a detailed study on the ‘pollution load from peri-urban to urban’ should be carried out to assess the WASH-borne vulnerability of both peri-urban and central urban population.

Fecal contamination poses a threat to groundwater supplies in low income regions. This is often due to the coexistence of pit latrines with domestic wells in densely populated areas. In this context, developing alternative methodologies to map fecal pollution in shallow wells is needed. A thorough survey of over 240 domestic wells and 570 pit latrines was conducted in a rural town of southern Mali. Water samples were collected from all wells and tested for temperature, pH, electric conductivity, total dissolved solids, turbidity and thermotolerant coliforms. The outcomes of the field survey were incorporated into a GIS database. Thirteen machine leaning classifiers, including different statistical algorithms, instance-based learners and tree-based models, were used to determine the spatial distribution of fecal pollution as per five explanatory variables (latrine density, distance to the closest latrine, borehole yield, water table depth and population density). The best performing classifiers, selected on test scores, were then used to develop predictive maps. Random forest and logistic regression rendered prediction scores for fecal pollution in excess of 0.90. Multilayer perceptrons, support vector machines and quadratic discriminant analyses also proved adept at forecasting fecal pollution. Ensemble mapping shows that 30–50 m buffers around domestic wells may be sufficient to prevent contamination of domestic supplies in most instances. This demonstrates that machine learning may provide a versatile methodological alternative to traditional Darcian approaches. On the other hand, the practical difficulties involved in maintaining wellhead protection areas suggests the need to implement piped water supplies.

The lack of proper on-site sanitation in unsewered low-income areas is becoming an important source of nutrient-rich wastewater leaching to groundwater and can potentially lead to eutrophication. For typical conditions in sub-Saharan Africa, the nutrient loading of nitrogen (N) and phosphorus (P) from on-site sanitation systems to aquifers is largely unknown. In this study, we assessed the dissolved nutrient loads (nitrate (NO3), ammonium (NH4) and orthophosphate (o-PO4)) and the processes likely affecting them in aquifers underlying two on-site sanitation systems in an unsewered low-income urban slum in Kampala, Uganda; a domestic solid waste dump and a site with two pit latrines. The impact of the two types of sites was assessed by comparing the upgradient and downgradient nutrient concentrations and loads along groundwater flow lines. Significant pollution to groundwater originated from the pit latrine site with downgradient nutrient loads increasing by factors of 1.7 for NO3, 10.5 for NH4 and 49 for o-PO4. No effect of leaching of nutrients to groundwater was found from the waste dump. We estimated that approximately 2–20% of total N and less than 1% of total P mass input was lost to groundwater from the pit latrines. The bulk of N leached to groundwater was in the form of NH4. Mn-reducing conditions prevailed in the shallow aquifer which suggested that nitrification was the main process affecting NH4 concentrations. Phosphorus was likely retained in the soils by precipitating as MnHPO4 and Ca5(PO4)3(OH). Our results indicated that pit latrines in alluvial aquifer systems can be highly effective for the removal of nutrients depending on hydrological, hydrochemical and geochemical conditions in the aquifer receiving wastewater. Improvements to make the current pit latrine systems better for nutrient containment are suggested based on findings from this study.

The aim of this article consists of developing an ecosystemic approach to collect information about groundwater pollution in order to determine its origin and infer the health risks in Mingoa's watershed through the study of 12 spontaneous settlements. From an environmental point of view, family interviews and direct observations allowed us to inventory springs, wells and latrines, and to collect information. So, we have selected, on the basis of predefined criteria, 21 wells and springs for physico-chemical and bacteriological laboratory analyses. Two hundred children aged less than 5 years were subjected to KOAP examination. A number of 1224 latrines were inventoried, for an average use of 15 people per latrine, producing 913.3 kg/year of excreta. Most of 91% of people use these latrines. The superficial aquifers, connected to the wells and springs, present high values of nitrogen, phosphorous pollutant and fecal contamination indicators (coliforms and fecal streptococcus), which make water inappropriate to human consumption. PCA analysis establishes that water pollution comes mainly from traditional pit latrines. The overall prevalence of diarrhea and parasite infestation was important (=40%). The presence of cysts of Entamoeba histolytica, Ascaris limbricoides, and Entamoeba coli confirms this high prevalence and testify to very approximate hygiene and environment conditions.

This paper examines the impact of drinking water quality and sanitation behavior on child health in rural districts of Ethiopia. Using primary household survey data and microbiological water test for Escherichia coli, we use various estimation methods to quantify the impacts of water quality and sanitation behavior on diarrhea incidence among children under five years old. Our results show that uncontaminated household storage water and safe child stool disposal decrease incidence of child diarrhea by 16% and 23% respectively. In contrast, neighborhood concentration of pit latrine increases incidence of child diarrhea by 12%. The latter result casts serious doubt on the assumed health and social benefits of moving from open to fixed-location defecation. Creating open defecation free communities in rural areas is not enough to achieve the desired health benefits of sanitation. To protect rural households from the risk of contracting communicable diseases, existing pit latrines should be upgraded to make them safer to use – fly-proofed and hygienic. There is a need for appropriate policy actions to improve household drinking water quality and to change people’s behavior towards safe sanitation practices. Increasing access to clean water supply and providing means for safe excreta disposal will bring significant health and social gains. Moreover, promotion of hygiene education campaigns about household water treatment, safe water storage and handling, washing hands with soaps at critical times, and adequately removing child feces from the domestic environment can also help ensure that people preserve good health in their household and their community.

Street food vendors in Kampala, Jinja and Masaka districts in Uganda were surveyed to assess risk factors, practices and knowledge of street food vendors with respect to food safety and hygiene. A total of 225 street food vendors were investigated from August 2008 and May 2009. A structured questionnaire and checklist were used in the interviews and focus group discussions. Street vendors (87.6%) were women and with low education level. Vendors had access to tap water within 5 min walk. Non-disposable plates/cups were the commonly used for vending food. Use of soap and cold water for washing utensils was common practice. Wash water recycled several times and only changed when very cloudy and soapy. Street vendors had some knowledge about diarrhoea and its associated risk factors. Toilet facilities were dominated by pour/flash toilet and pit latrine. Masaka (64.3%) and Jinja (38.9%) vendors disposed off the garbage at the vending sites whereas in Kampala (92.8%) used gunny bags.Cooked food was handled at ground level and exposed to flies. Masaka vendors (68.6%) had no hygiene regulations governing the street food vending business whereas Kampala (75.9%) and Jinja (65.3%) indicated hygiene regulations were enforced onsite management by local government. Vendors operated in a variety of vending structures and hygiene of premises was poor. Vendors suggested structural improvement of the vending sites and provision of more sanitary facilities. Street food vendors were aware hygienic practices, but do not put them in practice. Focus group discussants indicated a need to re-emphasize the personal hygiene and education. There is a need to reduce food contamination through education and provision of sanitary facilities at vending sites.

Coverage of adequate sanitation facilities in rural areas in Monkey Bay is low despite initiatives by Non Governmental Organisations (NGOs), government institutions and the local community. NGOs have donated cement, reinforcement bars, and moulds for making 4000 dome slabs. They also trained volunteers to help the communities construct latrines. In addition, they trained local leaders on sanitation and hygiene. The communities provided bricks, sand, quarry stone and labour as a prerequisite to benefit from donations by theNGOs. A follow up survey after the initial intervention revealed that out of 21314 (100%) households, 54.4% had traditional pit latrines of which 4% had dome slabs. Coverage of kitchens, bath shelters and refuse pits was 55%, 67% and 21%, respectively. This paper analyses sanitation initiatives by NGOs and local communities, factors attributing to lowcoverage of sanitation facilities and also sustainability of sanitation interventions in the area.

In the World Health Organisation (WHO) European Region, 120 million people do not have access to safe drinking water, and even more lack access to hygienic sanitary facilities. Better management of water and sanitation would prevent over 30 million cases of water-related disease per year in the region. Fewdata are collected or known about the access to adequate water supply and safe sanitation for public institutions such as schools. Since the independency in former Soviet states like Ukraine, Moldova, Armenia and others, existing central water and sewage systems are often badly maintained and no longer functioning. Women in Europe for a Common Future (WECF) gained experience on issues of water and sanitation in the rural areas of the new assessed EU countries Romania and Bulgaria and in 10 EECCA countries. WECF observed in the rural areas of those countries the most worse conditions of school sanitation: Groundwater is polluted by infiltration of nitrates and micro organism. Visiting the latrine is a threat to children’s health. The toilets are far away from the school, do not give privacy and are unhygienic. As much as possible, children and school staff try to avoid a visit of the facility by a low intake of liquids. During the period of menstruation girls prefer to stay at home. In demonstration projects, WECF has improved the sanitary condition of the schools and shown how to manage human excreta in an affordable, safe and sustainable way. It was shown, that even without a connection to the central water or sewage system, the dry urine-diverting toilet is a very fast and easy tool to improving the sanitary conditions of schools in an affordable and sustainable way, and to protect groundwater against infiltration of human excreta. School sanitation is an issue that needs the attention of regional, national and international policy makers. In order to improve the sanitary conditions in schools, regulations on the adoption of urine-diversion systems and the reuse of the human excreta in agriculture are needed.

Whilst groundwater vulnerability mapping and the delineation of resource and source protection zones have become an appropriate set of management tools for Britain as incorporated in European policy, much of semi-arid Africa is still dealing with more pressing issues centred on water supply coverage. There are a number of fundamental differences with Britain which disallow conventional vulnerability mapping and land zonation in much of Africa. Firstly, the scale of groundwater occurrence in weathered basement aquifers does not encourage vulnerability mapping to be undertaken at a field scale, whereas the Karoo and some of the larger areas of unconsolidated sedimentary aquifers could more readily be zoned according to aquifer vulnerability. Secondly, analysis needs to disregard the productivity (or recharge potential) of the aquifer so that poorly productive but socially important aquifers can be assessed. Such practice also avoids the need to identify a value for effective rainfall, a problematical value in semi-arid climates given current uncertainties. Thirdly, it is difficult to protect the many small and dispersed groundwater supply sources typical of many African communities when compared with the fewer and larger sources characteristic of Britain and Europe. Some aspects of European groundwater management practice have been transferred to the African context, notably by South Africa, but there are other practices that should not be attempted. Lessons from experience in South Africa highlight capacity to implement as a key inhibiting factor. Examples of vulnerability assessment and land zonation in a variety of African settings indicate only limited success so far with standard vulnerability assessment and land zonation techniques. Alternative means of quantifying the problem of the optimum proximity of the pit latrine from the well are highlighted, with a minimum separation of 10 m suggested for typical weathered basement rocks.

This paper examines the relationship between access to drinking water, sanitation facilities, and health outcomes for children in India. We use the NFHS 2005-2006 household-level survey data to construct the conditional nutritional distribution for two anthropometric health measures for children between ages six months to two years that capture both short term and longer term health outcomes: the weight-for-height ("wasting" - short term) and height-forage ("stunting" - long term) z-scores. Using a quantile regressions approach, we find that public goods such as piped water and access to healthcare facilities are not associated with improving child health outcomes. On the other hand, private investments within the home such as pit latrines and flush toilets do have a strong influence on health outcomes, with the magnitude of the effects being the largest in the middle of the respective conditional nutritional distributions. Further, rural children at the lower end of the nutritional distribution benefit much more than their urban counterparts. We also find that the educational attainment of the mother has a strong association with better health outcomes, both in the short run as well as the long run. Finally, access to well water and boiling drinking water also matter, though their effects depend on whether the underlying health measure is a short term or long term one, and the child's relative position in the conditional nutritional distribution. Over all, our results provide evidence against "one size fits all" policies, and point towards incentives for private investments in sanitation and mother's education, especially in rural areas and for children in the middle of the conditional nutritional distribution.

It is now well-accepted among policy makers that the provision of water, sanitation and hygiene is a basic human right. Yet, millions of people lack access to basic toilet facilities, which anecdotal evidence suggests may increase violence against women. We examine the relationship between the lack of toilet facilities in the Indian household on non-family violence (i.e. not family member) against Indian women. Using the latest 2005-2006 National Family Health Surveys (NFHS-3) data, we relate the lack of toilet facilities in Indian households (when members use bush or pit latrines to relieve themselves) to non-family violence against Indian women. Multilevel logistic regression results, using data from 60,847 Indian women, indicate that after controlling for economic prosperity and other covariates, lack of toilet facilities in the household is positively related to non-family violence against urban Indian women but not for rural Indian women. Further, this relationship is stronger for poor urban women. Additional analysis indicate that the findings are robust. The paper’s insights indicate that the lack of toilet facilities in households is a source of violence against urban Indian women. We offer policy recommendations to reduce non-family violence against urban Indian women.

In resource-poor and low-population-density areas, on-site sanitation is preferred to off-site sanitation and groundwater is the main source of water for domestic uses. Groundwater pollution potential from on-site sanitation in such areas conflicts with Integrated Water Resources Management (IWRM) principles that advocate for sustainable use of water resources. Given the widespread use of groundwater for domestic purposes in rural areas, maintaining groundwater quality is a critical livelihood intervention. This study assessed impacts of pit latrines on groundwater quality in Kamangira village, Marondera district, Zimbabwe. Groundwater samples from 14 monitoring boreholes and 3 shallow wells were analysed during 6 sampling campaigns, from February 2005 to May 2005. Parameters analysed were total and faecal coliforms, NH 4 + – N , NO 3 - – N , conductivity, turbidity and pH, both for boreholes and shallow wells. Total and faecal coliforms both ranged 0-TNTC (too-numerous-to-count), 78% of results meeting the 0 CFU/100 ml WHO guidelines value. NH 4 + – N range was 0–2.0 mg/l, with 99% of results falling below the 1.5 mg/l WHO recommended value. NO 3 - – N range was 0.0–6.7 mg/l, within 10 mg/l WHO guidelines value. The range for conductivity values was 46–370 μS/cm while the pH range was 6.8–7.9. There are no WHO guideline values for these two parameters. Turbidity ranged from 1 NTU to 45 NTU, 59% of results meeting the 5 NTU WHO guidelines limit. Depth from the ground surface to the water table for the period February 2005 to May 2005 was determined for all sampling points using a tape measure. The drop in water table averaged from 1.1 m to 1.9 m and these values were obtained by subtracting water table elevations from absolute ground surface elevation. Soil from the monitoring boreholes was classified as sandy. The soil infiltration layer was taken as the layer between the pit latrine bottom and the water table. It averaged from 1.3 m to 1.7 m above the water table for two latrines and 2–3.2 m below it for one pit latrine. A questionnaire survey revealed the prevalence of diarrhoea and structural failure of latrines. Results indicated that pit latrines were microbiologically impacting on groundwater quality up to 25 m lateral distance. Nitrogen values were of no immediate threat to health. The shallow water table increased pollution potential from pit latrines. Raised and lined pit latrines and other low-cost technologies should be considered to minimize potential of groundwater pollution.

Nearly half the world's population lacks basic sanitation to protect their environment from human fecal contamination. Building a latrine is the first step on the sanitation ladder in developing countries where a majority of the population defecates in open or public areas. Public health programs to improve sanitation have consistently framed promotional messages in terms of fecal-oral disease prevention and largely fail to motivate changes in sanitation behavior. A qualitative consumer study using in-depth interviews with 40 household heads was carried out to explore the decision to install a pit latrine in rural Benin. The motives for installing a latrine are reported and variations across the interviews are examined. The paper asserts that at least one active drive (desire for change or dissatisfaction) from among 11 found is needed to motivate latrine adoption. Drives involved prestige, well-being, and situational goals. Health considerations played only a minor role, and had little if anything to do with preventing fecal-oral disease transmission. Drives varied with gender, occupation, life stage, travel experience, education, and wealth, and reflected perceptions of the physical and social geography of the village, linked to availability of open defecation sites, social structure, road access, and urban proximity. The results have broad implications for new messages and strategies to promote sanitation in developing countries.

Human excreta are a natural resource which is always available in all societies. Unfortunately, their value is highly underestimated in present agriculture and horticulture including in many tropical developing countries. Especially human urine is rich in nitrogen. This ‘‘free’’ fertiliser should be used as much as possible and needed. In many cases, human urine and composted human faeces could be fortified with wood ash and kitchen and garden waste to meet the potassium and phosphorus needs of plants and to improve soil structure. Avoiding health risks and dosage requirements are also discussed. The ideas presented here can be used even with the cheap pit latrines that are common in the rural and peri-urban areas of developing countries. They do not require electricity and/or tap water. They may also fit conditions in areas of Eastern Europe where piped water and sewerage are absent and/or people lack money for fertilisers and maintenance of wastewater treatment plants.

Rapid urbanisation and lack of low cost accommodation in the City of Harare, Zimbabwe, led to a lot of people settling (formally or otherwise) on previously cultivated land in Epworth, south-east of the city. Groundwater quality in different parts of Epworth, a semi-formal settlement in Zimbabwe, was investigated. Water samples for water quality analysis were collected from 10 shallow boreholes and 20 shallow wells across the settlement. Results showed significantly elevated levels of nitrates and coliform bacteria in most parts of the settlement. Levels of coliforms were highest in the old parts of the settlement (>10,000 cfu). High nitrate levels (20–30 mg/l) can be related to more densely settled areas, with a higher density of pit latrines. The groundwater quality generally decreased downflow (to the south-east). Na, Zn, Cu, Co, Fe, PO4 were also determined, of which only iron showed substantially high levels. Groundwater quality results were used to delineate parts of the settlement into water use zones. Three broad zones were defined: Zone 1 (water drinkable after boiling), Zone 2 (water for agricultural use only), and Zone 3 (water unsuitable for domestic or agricultural purposes). The results also showed that most parts of the settlement have no safe groundwater for human consumption and Zone 1 could be faced with high nitrate levels in future. It is too late to prevent contamination of groundwater in this settlement. As a cost-effective measure to reduce health risk, the local authority could consider the provision of a limited water supply, via communal taps, starting in those areas in Zones 2 and 3 except for the south-east where there area already communal taps. A health education campaign on the risks of drinking polluted groundwater in this settlement is also necessary. The development of a sewage system is an alternative although it is expensive with the current situation. Furthermore, although a proper sewage reticulation system would prevent further groundwater contamination, the levels of nitrate will remain high, until flushed by recharge.

In Kampala City like most towns in Uganda, provision of treated piped water has been concentrated in high-income zones with very little improvement in the high-density, low-income areas where the majority of the urban population lives. This has left protected springs as a major source of domestic water. These springs are “protected” during construction by providing provisions in two parts; a permeable section of gravel and sand into which the source waters enter, and a dam which prevents the water from bypassing the catchment or reservoir. A perforated supply pipe leads the water out of the reservoir. Very few studies have been carried out to determine the extent of pollution of protected springs and none on the comparison of protected springs in high- and low-density settlements. This study, carried out both in the dry and wet seasons, was aimed at establishing the water quality of protected springs in Kampala and contributory pollution factors. Both high- and low-density settlement areas were studied. Survey using questionnaires and field observations were done to identify sources of pollutants and to relate them to human activities and explain the possible causes and sources of pollution of the springs. Pollution (chemical and biological) levels were higher in protected springs located in high-density settlement areas and this was attributed to poor waste-management practices. Human activities like construction of pit latrines, some located less than 5 m upstream of protected springs, animal husbandry and indiscriminate dumping of wastes contributed to the presence of high levels of chemical and biological pollutants in the protected springs. Average concentrations of nitrate-nitrogen (49.5 mg/l) and ammonium-nitrogen (7.3 mg/l) and faecal coliforms (1.8 × 10 4 no./100 ml) were recorded. Pollution levels were higher in the rainy season and this was attributed to storm water runoff and its infiltration into the ground water. The results indicate that water from protected springs poses a health risk to the communities using it.

Botswana is a semi-arid country with limited recharge to groundwater resources. Groundwater however is a major source of water for domestic, industrial and agricultural uses. There is therefore the need to ensure that the groundwater resources are of drinking quality, by protecting them against pollution sources such as landfills, pit latrines, industries, agricultural pesticides and waste. In this study a preliminary assessment of vulnerability of groundwater to pollution in Kanye well field in SE Botswana is undertaken. In order to assess the vulnerability of this aquifer to pollution, soils types, mapped geology and information from 82 boreholes were input into a GIS system to classify pollution vulnerability using Theissen polygons of the study area. Results indicate that 58% of the well field area is highly or very highly vulnerable to pollution, 34% is moderately vulnerable to pollution, and only 9% has low vulnerability. Estimates of the aquifer media characteristics in areas with only a few observations or few geological logs were considered to have higher uncertainty than areas with many observations. However, the use of the polynomial estimator enabled consideration of simple uncertainty for the aquifer media characteristics and pollution vulnerability modelling process.

Household water supply problems remain one of the major challenges facing developing countries. In Malawi, there is lack of documentation on the levels and causes of water pollution particularly in peri-urban areas so that meaningful interventions can be adopted. Therefore, a study was carried out in South Lunzu Township a peri-urban area in the city of Blantyre. The study revealed that the major form of sewerage disposal is the on-site sanitation system where about 58.8% of the respondents use traditional pit latrine while in terms of solid waste disposal, the Blantyre City Assembly which is responsible for solid waste collection, has only two collection vans to cater for more than half a million residents (Blantyre City Assembly, 1999. Urban Structure Plan, Draft Background Report, Blantyre.) hence indiscriminate disposal rampant in the area. Water samples collected from the major sources of domestic water supply showed that there are variations in the levels of water pollution between the ground water and surface water sources and between the wet and dry season. For instance, physically, the ground water turbidity levels were in the range of 2–12 mg/l during the dry season but increased to a maximum of 114 mg/l during the wet season while for surface water the turbidity increased from 4 to 408 mg/l over the seasons compared to the WHO standard set at 5 mg/l and the Water Department standard set at 25 mg/l. Chemical pollution for surface water sources show seasonal variations with an increase in the concentration during the wet season, for instance, iron levels ranged from 2.3 to 4.03 mg/l. This is above the WHO and Water Department drinking standards which are 1 and 3 mg/l, respectively. However, bacteriologically both the ground water and the surface water sources are grossly polluted. Ground water spring coliform count ranged from 190/100 ml to 9500/100 ml, and the well 3500/100 ml to 11,000/100 ml having the maximum during the wet season. Surface water results also indicated the coliform count ranging from 2900/100 ml to 4600/100 ml way higher than the WHO, MBS standard for drinking water which is 0 and the Water Department standard for untreated water of which range from 10–50 coliforms/100 ml. The results indicate that water resources have been polluted by lack of sanitation facilities, indiscriminate disposal of waste and the institutional set-up governing the provision of services in the area.

Stooi samples were collected for parasitological examination from a spatially stratified random sample of 194 households throughout Temeke District, a peri-urban area in Dar es Salaam,-Tanzania. Specimens were either examined on the same day or stored at + 4°C until examination on the next working day. They were prepared by the formol-ether concentration method and the Kato Katz technique (Katz et al., •ty 1972) was used to count the number of helminth eggs in each 50 g sample. A single • i microscopist (LM) examined every sample. J, Details of household composition, sanitation and socio-economic characteristics were ascertained by interview and a structured observation schedule. The economic status of households was assessed by enquiring, and where possible observing, i whether they owned any of a series of articles including a kerosene stove, a radio, a bicycle and a motorcycle. A weight was given to each item in accordance with its ; cost and rarity in Temeke at the time of the survey (late 1985), and a score derived by adding up the weights for all the items owned. i Of the population of 1168 covered by the survey, faecal samples were examined for only 621, or 53% of the total. However, there was no significant difference between the mean economic scores of those who submitted samples and those who did not. Every family interviewed had access to a latrine of some kind, but the majority shared them, usually with other tenants of the same landlord. All but a very few were simple pit latrines; three out of four had a cement floor. 95% of children aged

Trachoma a forgotten disease of forgotten people is a chronic follicular keratoconjunctivitis caused by Chlamydiae trachomatis. It is a disease that causes repeated infection of the conjunctiva and thus chronic inflammation producing scarring trichiasis corneal opacities and then blindness. Trachoma is an endemic disease that spreads easily from person to person in the community. Flies are one of the most important vectors of the disease. In today’s Lancet Paul Emerson and colleagues present a cluster-randomised study that was designed to investigate whether eye-seeking flies are trachoma vectors and whether household latrines can be used by trachoma control-programmes as a sustainable intervention. These researchers show that the provision of basic pit latrines to every household in a village without additional health education was effective in reducing the prevalence of trachoma. Thus their study shows that flies are vectors of trachoma. Their finding is consistent with many other studies. (excerpt)

The goals set at the Alma Ata Conference--community health care water and sanitation schemes mobile rural clinics for nomads and nutrition and immunization programs--are being implemented in the Kenyan bush by the African Medical and Research Foundation (AMREF). AMREF currently has over 100 projects underway in 5 states in East Africa a staff of 600 and an annual budget of 10 million pounds. Among AMREFs 24 projects in Kenya is the Turkana hydatid control effort. A community research program launched in 1976 in this nomadic group uncovered the epidemiology of hydatid found that it could be diagnosed by ultrasound and serology and demonstrated the effectiveness of treatment with albendazole. 10% of tribe members were affected by the disease which was spread through the practice of having dogs clean up infants bowel movements. AMREFs mobile clinics include not only nurses parasitologists and laboratory technicians but also an anthropologist charged with devising ways of getting the tribe to abandon this tradition. AMREF has been able to establish community-based primary health care among another nomadic tribe the Maasai because this group is large enough to have base to which the adults return and the young and elderly never leave. Here community health workers are attempting to reduce the prevalence--now at 60% of village children--of trachoma. This infection is spread by contaminated drinking water and flies that are drawn to the huts constructed of cow dung and branches. Most successful has been a primary health care project among the Kamba in Kibwezi which includes monthly training for birth attendants construction of pit latrines community-based contraceptive distribution clean water projects a scheme for the rehabilitation of the disabled a health center and an information office to collect data on unmet needs.

Groups of villagers, the care groups, are involved in prevention and treatment of trachoma within their own communities. The effect of the scheme on standards of hygiene and prevalence of trachoma has been evaluated by randomised cluster sampling methods. The number of households who were digging refuse pits, acquired individual face cloths and were aware of the role of good hygiene in the prevention of trachoma exceeded significantly those in (control) villages without a care group, in contrast the acquisition of pit latrines showed an insignificant increase. The prevalence and intensity of active trachoma was found to be significantly reduced as a result of the intervention of the care groups. This scheme has been totally integrated into the primary health care system of the area.