Assessment of sanitation infrastructure resilience to extreme rainfall and flooding: Evidence from an informal settlement in Kenya.

Sanitation infrastructure can fail during heavy rainfall and flooding, allowing the release of fecal waste - and the pathogens it carries - into spaces where people live, work, and play. However, there is a scarcity of reliable frameworks that can effectively assess the resilience of such infrastructure to extreme rainfall and flooding events. The purpose of this study was to develop and apply a novel framework for assessing and ranking the resilience of sanitation infrastructure in informal settlements. A framework for assessing sanitation infrastructure resilience was developed consisting of 19 indicators that were categorized into three domains: physical infrastructure design (8 indicators), operations and management (5 indicators), and environmental factors (6 indicators). The framework was applied to data from 200 shared sanitation facilities in Kibera, Kenya, collected through transect walks, field observations, surveys, and sanitary risk inspections. Results indicate that sanitation infrastructure type impacts resilience. Toilet facilities connected to a piped sewer (r = 1.345, 95% CI: 1.19-1.50) and toilets connected to a septic system (r = 1.014, 95% CI: 0.78-1.25) demonstrated higher levels of resilience compared to latrines (r = 0.663, 95% CI: 0.36-0.97) and hanging toilets (r = 0.014, 95% CI: 0.30-0.33) on a scale ranging from 0 to 4. The key determinants of sanitation infrastructure resilience were physical design, functionality, operational and maintenance routines, and environmental factors. This evidence provides valuable insights for developing standards and guidelines for the design and safe siting of new sanitation infrastructure and encourages investment in sewer and septic systems as superior options for resilient sanitation infrastructure. Additionally, our findings underscore the importance for implementers and communities to prioritize repairing damaged infrastructure, sealing potential discharge points into open drains, and emptying filled containment systems before the onset of the rainy season.

Regulating Citywide Inclusive Sanitation (CWIS) in Colombia.

The conventional top-down scope of relying only on centralised sewerage has proven insufficient to reach the entire global population with safely managed sanitation and meet Sustainable Development Goals 6.2. and 6.3 by 2030. Citywide Inclusive Sanitation (CWIS) has emerged as an approach to accelerate progress by considering different technologies and service provision models within the same city to expand sanitation access equitably and sustainably. However, to generate an enabling environment for CWIS to be implemented successfully, regulatory frameworks must be adapted, as they are often unsuited for non-sewered sanitation solutions. By analysing the Colombian case study through a mixed qualitative methodology comprised of a policy review, semi-structured interviews, and workshops with key stakeholders in the urban sanitation sector, the country's regulatory framework was evaluated to determine if it is adequate to implement CWIS. Regulations were identified to pose barriers for CWIS and produced a disabling environment for its application. This research proposes recommendations to adapt the regulatory framework to allow CWIS application in Colombia based on the encountered barriers. This is the first comprehensive study on regulations for CWIS in the Latin American context and therefore provides the basis for further research to understand the dynamics related to effective regulations for CWIS globally.

Out of sight, out of mind: Understanding the sanitation crisis in global South cities.

Global monitoring efforts do not provide a clear picture of the challenge of managing human waste at the city scale. Where cities do not provide universal access to publicly managed sanitation systems, households and communities find their own solutions resulting in a patchwork of approaches to removing human waste from places where people live. In dense urban environments, the absence of a coordinated approach can create serious public health problems. In the absence of comparable city-level data, we analyze primary and secondary data from 15 cities and 15 informal settlements in sub-Saharan Africa, South Asia, and Latin America. Across these regions, our study finds that 62 percent of human waste is not safely managed. We also find that, while many cities have a proportion of households connected to sewers, none of the 15 cities safely manage human waste at scale. In the absence of sewers, on-site fecal sludge management systems place enormous responsibility on households and private providers, and unaffordable sanitation options result in risky sanitation practices.

Detection and Quantification of Enteric Pathogens in Aerosols Near Open Wastewater Canals in Cities with Poor Sanitation.

Urban sanitation infrastructure is inadequate in many low-income countries, leading to the presence of highly concentrated, uncontained fecal waste streams in densely populated areas. Combined with mechanisms of aerosolization, airborne transport of enteric microbes and their genetic material is possible in such settings but remains poorly characterized. We detected and quantified enteric pathogen-associated gene targets in aerosol samples near open wastewater canals (OWCs) or impacted (receiving sewage or wastewater) surface waters and control sites in La Paz, Bolivia; Kanpur, India; and Atlanta, USA, via multiplex reverse-transcription qPCR (37 targets) and ddPCR (13 targets). We detected a wide range of enteric targets, some not previously reported in extramural urban aerosols, with more frequent detections of all enteric targets at higher densities in La Paz and Kanpur near OWCs. We report density estimates ranging up to 4.7 × 102 gc per mair3 across all targets including heat-stable enterotoxigenic Escherichia coli, Campylobacter jejuni, enteroinvasive E. coli/Shigella spp., Salmonella spp., norovirus, and Cryptosporidium spp. Estimated 25, 76, and 0% of samples containing positive pathogen detects were accompanied by culturable E. coli in La Paz, Kanpur, and Atlanta, respectively, suggesting potential for viability of enteric microbes at the point of sampling. Airborne transmission of enteric pathogens merits further investigation in cities with poor sanitation.

Re-conceptualizing sustainable urban sanitation in Uganda: why the roots of 'Slumification' must be dealt with.

BACKGROUND: Country-wide urbanization in Uganda has continued amidst institutional challenges. Previous interventions in the water and sanitation sector have not addressed the underlying issues of a poorly managed urbanization processes. Poor urbanisation is linked to low productivity, urban poverty, unemployment, limited capacity to plan and offer basic services as well as a failure to enforce urban standards. METHODS: This ethnographic study was carried out in three urban centres of Gulu, Mbarara and Kampala. We explored relationships between urban livelihoods and sustainable urban sanitation, using the economic sociology of urban sanitation framework. This framework locates the urbanization narrative within a complex system entailing demand, supply, access, use and sustainability of slum sanitation. We used both inductive and deductive thematic analysis. RESULTS: More than any other city in Uganda, Kampala was plagued with poor sanitation services characterized by a mismatch between demand and the available capacity for service provision. Poor slum sanitation was driven by; the need to escape rural poverty through urban migration, urban governance deficits, corruption and the survival imperative, poor service delivery and lack of capacity, pervasive (urban) informality, lack of standards: 'to whom it may concern' attitudes and the normalization of risk as a way of life. Amidst a general lack of affordability, there was a critical lack of public good conscience. Most urbanites were trapped in poverty, whereby economic survival trumped for the need for meeting desirable sanitation standards. CONCLUSIONS: Providing sustainable urban livelihoods and meeting sanitation demands is nested within sustainable livelihoods. Previous interventions have labored to fix the sanitation problem in slums without considering the drivers of this problem. Sustainable urban livelihoods are critical in reducing slums, improving slum living and curtailing the onset of slumification. Urban authorities need to make urban centres economically vibrant as an integral strategy for attaining better sanitation standards.

Will Households Invest in Safe Sanitation? Results from an Experimental Demand Trial in Nakuru, Kenya.

Unsafe sanitation is an increasing public health concern for rapidly expanding cities in low-income countries. Understanding household demand for improved sanitation infrastructure is critical for planning effective sanitation investments. In this study, we compared the stated and revealed willingness to pay (WTP) for high-quality, pour-flush latrines among households in low-income areas in the city of Nakuru, Kenya. We found that stated WTP for high-quality, pour-flush latrines was much lower than market prices: less than 5% of households were willing to pay the full costs, which we estimated between 87,100-82,900 Kenyan Shillings (KES), or 871-829 USD. In addition, we found large discrepancies between stated and revealed WTP. For example, 90% of households stated that they would be willing to pay a discounted amount of 10,000 KES (100 USD) for a high-quality, pour-flush latrine, but only 10% of households redeemed vouchers at this price point (paid via six installment payments). Households reported that financial constraints (i.e., lack of cash, other spending priorities) were the main barriers to voucher redemption, even at highly discounted prices. Our results emphasize the importance of financial interventions that address the sizable gaps between the costs of sanitation products and customer demand among low-income populations.

Planning fecal sludge management systems: Challenges observed in a small town in southern India.

Fecal Sludge Treatment or Septage Management is increasingly being recognised as an effective and appropriate method to scale urban sanitation systems to achieve safe sanitation, particularly in small towns and cities. As implementation progresses, data-based evidence is emerging, highlighting the challenges faced on the ground, and the requisite planning necessary to address them. This paper presents the findings, challenges and possible ways ahead from a study conducted to provide data for Fecal Sludge Management (FSM) planning for a small town in a state in southern India. With the objective of understanding the nature of containment structures and on-ground desludging practices, 8,001 households and 1,667 establishments were studied in Periyanaicken-Palayam (PNP), a non-sewered Town Panchayat in Coimbatore District, Tamil Nadu, to provide evidence for effective decision-making. The study showed wide variations in the sizing and design of the containment systems, which, when combined with the irregular frequency of desludging, has implications for FSM planning by municipal bodies. This study also highlights the methodological difficulties in studying containment systems, exposes a significant response bias given the limited understanding of containment systems within households, and spotlights the difficulty in physically verifying the reported data given the underground nature of these systems.

Inequalities in the access to healthy urban structure and housing: an analysis of the Brazilian census data / Desigualdades no acesso a infraestrutura urbana e moradia saudáveis: uma análise dos dados do censo brasileiro / Inequidades en el acceso a entornos urbanos saludables y vivienda: un análisis de datos del censo brasileño

Abstract: This study aims (1) to test the association between access to basic sanitation/hygiene services in Brazilian households with their householders' socioeconomic and demographic characteristics; (2) to analyze the distribution of urban health-relevant elements in the census tracts according to their income, education and race/color composition. The information come from the 2010 Brazilian Demographic Census, which collected data regarding both household conditions and urban structure of the census tracts. Prevalence ratios were calculated using crude and adjusted Poisson regression models. The proportional distribution of the census-tract urban structure was performed, according to the deciles of the exploratory variables, and the ratios and the absolute differences between the extreme deciles were calculated. Around 4.8% of the households had no piped water, 34.7% had no sewage collection system, 9.8% had no garbage collection and 39% were considered inadequate. Families whose householders were black, indigenous or brown had lower income and educational level, and lived in the North, Northeast, and Central West regions. They were more likely to be considered inappropriate for not having piped water, sewage collection system, and garbage collection. Moreover, sectors where the majority of the population was black, had lower educational levels and lower income had significantly poor paving, street lighting, afforestation, storm drain, sidewalk and wheelchair ramp. This study analyzed national data from 2010 and provides a baseline for future studies and government planning. The relevant social inequalities reported in this study need to be addressed by effective public policies.

Resumo: Os objetivos do estudo foram: (1) testar a associação entre os serviços de saneamento básico/higiene nos domicílios brasileiros e as características socioeconômicas e demográficas dos/das chefes de família e (2) analisar a distribuição dos elementos urbanos relacionados à saúde nos distritos sanitários de acordo com a composição de renda, escolaridade e raça/cor. Os dados foram obtidos do Censo Demográfico de 2010, que coletou informações sobre as condições do domicílio e a infraestrutura urbana dos distritos censitários. Foram calculadas as razões de prevalência, usando modelos de regressão Poisson simples e ajustada. Foi avaliada a distribuição proporcional da infraestrutura urbana nos distritos censitários de acordo com os decis das variáveis exploratórias, e foram calculadas as razões e diferenças absolutas entre os decis extremos. Cerca de 4,8% dos domicílios não dispunham de água encanada, 34,7% faltavam esgotamento sanitário, 9,8% não tinham coleta de lixo e 39% das moradias eram consideradas inadequadas. Os domicílios chefiados por pretos/as, pardos/as ou indígenas apresentavam níveis mais baixos de renda e escolaridade, e aqueles localizados no Norte, Nordeste e Centro-oeste tinham níveis maiores de moradia inadequada e falta de água encanada, esgotamento sanitário e coleta de lixo. Além disso, os distritos com maioria negra e com menores níveis de escolaridade e renda apresentavam menores coberturas de pavimentação, iluminação e arborização de ruas, galerias pluviais, calçadas e rampas para cadeira de rodas. O estudo analisou os dados de 2010 e estabeleceu uma linha de base para estudos futuros e planejamento de políticas de governo. As desigualdades sociais relevantes relatadas no estudo devem ser enfrentadas com políticas públicas efetivas.

Resumen: Los objetivos de este estudio son: (1) probar la asociación entre el acceso a servicios básicos de higiene y saneamiento en los hogares brasileños con sus principales características socioeconómicas y demográficas; (2) analizar la distribución de elementos urbanos relevantes para la salud en secciones censales, según la composición de sus ingresos, educación y raza/color. Los datos provienen del Censo Demográfico de 2010, que recogió datos, tanto respecto a las condiciones de los hogares, como al entorno urbano de las secciones censales. Las ratios de prevalencia se calcularon usando modelos de regresión crudos y ajustados de Poisson. Se realizó una distribución proporcional de las secciones censales relacionadas con el entorno urbano, según deciles de las variables exploratorias y las ratios, y se calcularon las diferencias absolutas entre los deciles extremos. Alrededor de un 4,8% de los hogares no contaban con agua canalizada, 34,7% no tenían un sistema de alcantarillado, un 9,8% no tenían recogida de basuras y un 39% de los hogares fueron considerados inadecuados. Hogares, cuyas cabezas de familia eran negros, indígenas o mulatos/mestizos, tenían bajos ingresos, educación, y vivían en el Norte, Noreste, y Centro-oeste tuvieron más probabilidad de ser considerados inapropiados, no contar con agua canalizada, sistema de alcantarillado y recogida de basuras. Además, los sectores donde la mayoría de la población era negra, con bajos niveles educativos e ingresos más bajos tenían significativamente menos cobertura de pavimentación, iluminación de calles, forestación, alcantarillado pluvial, aceras y rampas de acceso para sillas de ruedas. Este estudio analizó los datos nacionales desde 2010 y proporciona una base de referencia para futuros estudios y planificación gubernamental. Las inequidades relevantes sociales reflejadas en este estudio necesitan que ser tratadas mediante políticas públicas eficientes.

Strategies to Connect Low-Income Communities with the Proposed Sewerage Network of the Dhaka Sanitation Improvement Project, Bangladesh: A Qualitative Assessment of the Perspectives of Stakeholders.

In Bangladesh, approximately 31% of urban residents are living without safely managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing low-income communities (LICs) under a sewerage connection within the proposed sewerage network plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bills equally among sharing households, or by users per household. Participants also suggested the government's cooperation with development-partners/NGOs to ensure sewerage connection construction, operation, and maintenance and prerequisite policy changes such as assuring land tenure.

Sustainability indicators for municipal solid waste management: A case study of the Recife Metropolitan Region, Brazil.

Municipal solid waste (MSW) management in Brazil faces major challenges in order to meet the requirements proposed by the National Solid Waste Policy, which has been in force since 2010 and complicates decision-making, especially in small municipalities. In this context, sustainability indicators are important support tools that help in setting out performance actions for municipal sustainable development. The main objective of this article is to evaluate the four sustainability dimensions (social, environmental, economic, and legal/institutional) using sustainability indicators for MSW management in the Recife Metropolitan Region (RMR) in Northeast Brazil. To do this, the progress of the region was evaluated against the principal goals and guidelines proposed by solid waste plans and by the United Nations Sustainable Development Goals. It was found that some progress has been achieved in recent years, such as the closure of dumps, a reduction of the per capita MSW mass collected, and an increase in the coverage rate for solid household waste collection. However, selective collection and financial autonomy still fall well short of the region's goals. According to the results of this study, municipalities in the RMR require more environmental education and joint actions involving government, the private sector, and the general population.

Urban sanitation in Nigeria: the past, current and future status of access, policies and institutions.

Though rated among the largest economies in sub-Saharan Africa, Nigeria is currently grappling with enormous socio-economic challenges such as high poverty rate, power and water supply shortages, large-scale unemployment ratio, economic recession and underperforming agricultural sector. Judging by the scale of urgent political and economic importance, urban sanitation definitely ranks low among the government's priorities. No wonder political slogans and manifestos of political parties feature provision of water supply while sanitation is conspicuously usually omitted. This is suggestive of the opinion that having not critically understood the status, challenges and opportunities associated with sanitation in the country's urban areas might be partly responsible for this. Thus, the current work presents a detailed review of the past, current and future status of urban sanitation in Nigeria in terms of access coverage, policies, institutions and future challenges and opportunities. The past status was difficult to evaluate because of the absence of data and unclear definitions of the term 'sanitation'. The current status shows among other findings that water supply issues receive domineering attention than sanitation, mainly due to merging together of discussions, policies and implementation of the two issues together. In cases where sanitation crops up in the agenda, rural areas are favored more than the urban areas. This pattern is also common in the literature. But the future of urban sanitation in Nigeria is double-edged depending on actions or inactions of the government and other stakeholders. The study further makes recommendations for - balanced and sustainable urban development planning, restructuring of land and housing policies and creation of enabling market environment that could trigger a viable sanitation industry - as the way forward.

Desafios para o investimento público em saneamento no Brasil / Challenges for public investment in sanitation in Brazil

RESUMO Este estudo investiga o desempenho dos principais programas de investimento em saneamento no âmbito do Programa de Aceleração do Crescimento (PAC) para mostrar se a escassez de recursos é o que explica o fracasso dessa política no País, como sustentam as atuais propostas de reforma do setor em tramitação. A partir dos dados sistematizados no Siga-Brasil e da análise dos relatórios dos órgãos de controle, foi possível reconstituir a trajetória de execução orçamentária dos programas e identificar as principais dificuldades enfrentadas para a sua operacionalização. À luz da literatura disponível, percebe-se que a estratégia federal centrada no incentivo financeiro reduziu o protagonismo da União ao repasse de verbas, quando era necessária uma atuação mais incisiva quanto aos problemas estruturais apresentados por municípios e estados brasileiros. Nesse sentido, o baixo gasto orçamentário estaria menos ligado à disponibilidade dos recursos que aos obstáculos institucionais encontrados em nível local, onde a política de saneamento é primariamente executada. Por fim, alerta-se para a necessidade de pensar arranjos de colaboração federativa mais eficazes em reduzir os custos transacionais de implementação dessa política, especialmente agora em que os cortes de orçamento ameaçam o fluxo de investimentos no setor.

ABSTRACT This paper focus on the performance of the main programs of investment in sanitation within the scope of the GAP (Growth Acceleration Program - PAC) to show if scarcity of resources itself can explain the failure of such policy in the country, as supported by the current proposals to change regulation. Based on the data available in the Siga-Brasil database, and in the reports made by the existing accountability institutions, we were able to track the expenses of the projects and identifying the main difficulties which prevented them from succeeding. Based on the literature available, we could infer that the federal strategy focused mainly on financial incentive reduced the Union's role as an agent of transferring of funds, instead of acting on the main structural problems of the sector, found in Brazilian municipalities and states. In that sense, it concludes that underfunding would not have been the cause, but rather a reflection of the obstacles faced by the Union's strategy at the local levels, in which this policy is actually implemented. Finally, it recommends that we should think about new arrangements to reduce the transactional costs of the policy, especially now that cuts on public budget have interrupted the flow of investments to the sector.

What Proportion Counts? Disaggregating Access to Safely Managed Sanitation in an Emerging Town in Tanzania.

Sustainable Development Goal (SDG) 6.2 sets an ambitious target of leaving no-one without adequate and equitable sanitation by 2030. The key concern is the lack of local human and financial capital to fund the collection of reliable information to monitor progress towards the goal. As a result, national and local records may be telling a different story of the proportion of safely managed sanitation that counts towards achieving the SDG. This paper unveils such inconsistency in sanitation data generated by urban authorities and proposes a simple approach for collecting reliable and verifiable information on access to safely managed sanitation. The paper is based on a study conducted in Babati Town Council in Tanzania. Using a smartphone-based survey tool, city health officers were trained to map 17,383 housing units in the town. A housing unit may comprise of two or more households. The findings show that 5% practice open defecation, while 82% of the housing units have some form of sanitation. Despite the extensive coverage, only 31% of the fecal sludge generated is safely contained, while 64% is not. This study demonstrates the possibility of using simple survey tools to collect reliable data for monitoring progress towards safely managed sanitation in the towns of global South.

The Sustainable Development Goal for Urban Sanitation: Africa's Statistical Tragedy Continues?

Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. There are a number of improvements in the new measure. However, despite the improvements, the new measure continues to be characterized by an important flaw: it continues to disregard how shared toilet facilities contribute towards the SDG sanitation target. As a result, the new measure does not indicate whether progress is being made in low-income urban areas where a large number of households rely on shared sanitation; nor does it provide a goal that can be achieved in cities of the poorest countries over the measurement period. But, its most egregious failing is that it directs resources towards investments which will often fail cost/benefit tests. In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.

Generation of sanitation system options for urban planning considering novel technologies.

The identification of appropriate sanitation systems is particularly challenging in developing urban areas where local needs are not met by conventional solutions. While structured decision-making frameworks such as Community-Led Urban Environmental Sanitation (CLUES) can help facilitate this process, they require a set of sanitation system options as input. Given the large number of possible combinations of sanitation technologies, the generation of a good set of sanitation system options is far from trivial. This paper presents a procedure for generating a set of locally appropriate sanitation system options, which can then be used in a structured decision-making process. The systematic and partly automated procedure was designed (i) to enhance the reproducibility of option generation; (ii) to consider all types of conventional and novel technologies; (iii) to provide a set of sanitation systems that is technologically diverse; and (iv) to formally account for uncertainties linked to technology specifications and local conditions. We applied the procedure to an emerging small town in Nepal. We assessed the appropriateness of 40 technologies and generated 17,955 appropriate system options. These were classified into 16 system templates including on-site, urine-diverting, biogas, and blackwater templates. From these, a subset of 36 most appropriate sanitation system options were selected, which included both conventional and novel options. We performed a sensitivity analysis to evaluate the impact of different elements on the diversity and appropriateness of the set of selected sanitation system options. We found that the use of system templates is most important, followed by the use of a weighted multiplicative aggregation function to quantify local appropriateness. We also show that the optimal size of the set of selected sanitation system options is equal to or slightly greater than the number of system templates. As novel technologies are developed and added to the already large portfolio of technology options, the procedure presented in this work may become an essential tool for generating and exploring appropriate sanitation system options.

Faecal Pathogen Flows and Their Public Health Risks in Urban Environments: A Proposed Approach to Inform Sanitation Planning.

Public health benefits are often a key political driver of urban sanitation investment in developing countries, however, pathogen flows are rarely taken systematically into account in sanitation investment choices. While several tools and approaches on sanitation and health risks have recently been developed, this research identified gaps in their ability to predict faecal pathogen flows, to relate exposure risks to the existing sanitation services, and to compare expected impacts of improvements. This paper outlines a conceptual approach that links faecal waste discharge patterns with potential pathogen exposure pathways to quantitatively compare urban sanitation improvement options. An illustrative application of the approach is presented, using a spreadsheet-based model to compare the relative effect on disability-adjusted life years of six sanitation improvement options for a hypothetical urban situation. The approach includes consideration of the persistence or removal of different pathogen classes in different environments; recognition of multiple interconnected sludge and effluent pathways, and of multiple potential sites for exposure; and use of quantitative microbial risk assessment to support prediction of relative health risks for each option. This research provides a step forward in applying current knowledge to better consider public health, alongside environmental and other objectives, in urban sanitation decision making. Further empirical research in specific locations is now required to refine the approach and address data gaps.

Piloting a low-cost hardware intervention to reduce improper disposal of solid waste in communal toilets in low-income settlements in Dhaka, Bangladesh.

BACKGROUND: Bangladesh faces daunting challenges in addressing the sanitation needs of its urban poor. Maintaining the cleanliness and functionality of communal toilets is dependent upon periodic emptying of fecal sludge, and cooperation between users of communal toilets. Trash disposal into latrines can block the outflow pipes, rendering the toilets non-functional. METHODS: Pre-intervention: We conducted in-depth interviews with five operators of fecal sludge emptying equipment and five adult residents who were also caregivers of children. We identified factors contributing to improper disposal of trash into communal toilets, a barrier to operation of the equipment, in low-income communities of Dhaka, Bangladesh. Intervention design: We developed behavior change communication materials to discourage waste disposal in toilets, and promote use of waste bins. We conducted six focus group discussions with adult male, female, landlord and children to select the preferred design for waste bins to be placed inside toilets, and finalize communication materials. Post-intervention: We then pilot-tested an intervention package to promote appropriate trash disposal practices and thus facilitate periodic removal of fecal sludge when the latrine pits become full. We conducted 20 in-depth interviews and four focus group discussions with community residents, landlords and cleaners of communal toilets. RESULTS: Barriers to appropriate waste disposal included lack of private location for disposal of menstrual hygiene products, limited options for formal trash collection and disposal, and the use of plastic bags for disposing children's feces. A pilot intervention including behavior change communication and trash bins was implemented in two urban slum communities. Spot checks confirmed that the bins were in place and used. Respondents described positive improvements in the appearance of the toilet and surrounding environment. CONCLUSION: The current practice on the part of local residents of disposing of waste into toilets impedes the safe removal of fecal sludge and impairs toilet functionality. Residents reported positive changes in toilet cleanliness and usability resulting from this intervention, and this both improves the user experience with toilets, and also promotes the sustainability of the entrepreneurial model of Vacutug operators supported by WSUP.

Transmissão urbana da esquistossomose: novo cenário epidemiológico na Zona da Mata de Pernambuco / Urban transmission of schistosomiasis: new epidemiological situation in the forest area of Pernambuco

RESUMO: Introdução: A esquistossomose é considerada uma endemia em Vitória de Santo Antão, Pernambuco, o qual apresenta há décadas altas incidências e prevalências para essa doença. Nesse município ocorre a transmissão clássica da doença por meio do contato da população de áreas rurais com águas contaminadas durante o desenvolvimento de suas atividades de vida diárias. Recentemente surgiram indícios da presença do caramujo vetor na área urbana da cidade, o que pode configurar um novo modelo de transmissão para esquistossomose nesse município. Objetivo: Identificar novo cenário epidemiológico para ocorrência da transmissão urbana da esquistossomose em Vitória de Santo Antão, Pernambuco. Métodos: Foi conduzido um inquérito malacológico, investigando-se todas as coleções hídricas do perímetro urbano quanto à presença do caramujo vetor da esquistossomose (Biomphalaria spp.). Os caramujos coletados foram examinados para identificação taxonômica e de infecção pelo Schistosoma mansoni. Todos os criadouros (CRs) foram georreferenciados para construção de mapas de risco por meio dos software TrackMaker-Pro e ArcGIS. Resultados: Foram identificados 22 CRs da espécie Biomphalaria straminea, nos quais foram coletados 1.704 caramujos. Desses CRs, um foi identificado como foco de transmissão da doença e sete como focos potenciais para transmissão. Os mapas construídos identificaram duas áreas de risco para transmissão urbana da esquistossomose, bem como áreas de expansão dos CRs, configurando um aumento no risco de transmissão para a população. Conclusão: Os resultados constatam a existência de um novo cenário epidemiológico, no qual a possibilidade de transmissão urbana dessa doença foi confirmada.

ABSTRACT: Introduction: Schistosomiasis is considered an endemic disease in Vitória de Santo Antão, Pernambuco, a district which has presented both high incidence and prevalence of it for decades. Poor environmental conditions lead to contamination of water sources in rural areas, which are used by the population during daily activities, resulting in typical transmission. Recently, there has been evidence of vector snails in urban areas, which could set a new model for schistosomiasis transmission in this district. Objective: To identify the new epidemiological situation for the urban transmission of schistosomiasis in Vitória de Santo Antão, Pernambuco. Methods: A malacological survey was conducted in all water sources in the city limits to investigate schistosomiasis vector snails (Biomphalaria spp.). The collected snails were examined for taxonomic identification and Schistosoma mansoni infection. All breeding sites were georeferenced to build risk maps through the TrackMaker PRO program and ArcGIS software. Results: We identified 22 Biomphalaria straminea breeding sites and collected 1,704 snails. One of these breeding sites was identified as a source of transmission and seven as potential sources of transmission. The designed maps identified two risk areas of urban transmission of schistosomiasis and expansion areas for breeding sites, establishing an increased risk of transmission to the population. Conclusion: This study verified the existence of a new epidemiological situation in which the possibility of the urban transmission of the disease was confirmed.

Waging War on Mosquitoes: Scientific Research and the Formation of Mosquito Brigades in French West Africa, 1899-1920.

While the majority of colonial public health officials in Africa intermittently used measures for mosquito containment, the government of French West Africa made the creation of what were called mosquito brigades into a vital element of urban sanitary policy. The project seemed to offer a chance to curb the impact of mosquito-borne disease on the colonial economy. Yet, despite the full support of sanitary policy on the federal, colonial, and local levels, the government found that conducting a "War on Mosquitoes" was far more difficult than they originally envisioned. The colonial government's mosquito brigades were understaffed and often ran into resistance from both the African and European populations. Above all, the government's urban mosquito control programs failed because their goal of controlling the breeding of mosquitoes lay beyond the limited capabilities of the both local government and the Federation's health and sanitation services. This paper will examine the origins and fate of the French West African mosquito brigades and provide a context for analyzing their atypical place among colonial efforts at malaria prevention.

Prevalência de parasitoses intestinais e condições de saneamento básico das moradias em escolares da zona urbana de Caxias do Sul, Rio Grande do Sul / Prevalence of intestinal parasites among schoolchildren and household sanitation in the urban area of Caxias do Sul, State of Rio Grande do Sul, Brazil

Objetivos: Avaliar a prevalência de parasitas intestinais em escolares de Caxias do Sul, relacionando-a com as condições de saneamento das moradias e com o conhecimento sobre parasitoses autorrelatado pelos familiares. Métodos: Foram incluídas no estudo crianças com idade entre cinco e 13 anos, de escolas municipais de ensino fundamental localizadas em zona urbana de Caxias do Sul, Rio Grande do Sul, incluindo a periferia e as zonas centrais da cidade. As amostras foram processadas por sedimentação espontânea e analisadas microscopicamente. Os responsáveis pelos escolares responderam a um questionário elaborado para identificar condições socioeconômicas da família e de saneamento ambiental, assim como a impressão que os mesmos tinham sobre os seus conhecimentos acerca de parasitoses. Resultados: A amostra foi constituída por 257 escolares, com idade média de 8,7±1,3 anos, sendo 58% do sexo feminino. Das amostras de fezes analisadas, 5,8% foram positivas para parasitas, sendo 60% cistos de Endolimax nana, 26,7% de Entamoeba coli e 13,3% de Giardia lamblia. Com respeito às condições de vida dos escolares, 99,2% consumiam água potável, 94,6% afirmaram ter coleta e tratamento de esgoto e 99,2% contava com coleta pública de lixo na moradia. Sobre o conhecimento de parasitoses, 74,7% dos responsáveis sabiam o que são parasitas e 67,3% relataram que conheciam os meios de transmissão. No entanto, 49,8% consideravam as informações insuficientes para a prevenção de parasitoses. Conclusões: O estudo evidenciou uma baixa prevalência de parasitoses nos escolares e condições favoráveis de saneamento em suas moradias. Houve relato de grande frequência de uso de medicamentos antiparasitários sem diagnóstico prévio por exame de fezes.

Aims: To evaluate the prevalence of intestinal parasites among schoolchildren from Caxias do Sul, State of Rio Grande do Sul, southern Brazil, associating it with household sanitation and with family members' self-reported knowledge about parasites. Methods: Children aged 5 to 13 years attending local elementary schools in the urban area of Caxias do Sul, including the outskirts and downtown area, were included in the study. The samples were processed by spontaneous sedimentation and analyzed microscopically. The children's legal representatives answered a questionnaire on socioeconomic conditions and sanitation as well as on their knowledge about parasitic infections. Results: The sample included 257 schoolchildren with a mean age of 8.7±1.3 years, most of whom were female (58%). Of the analyzed stool samples, 5.8% were positive for parasitic cysts: Endolimax nana (60%), Entamoeba coli (26.7%), and Giardia lamblia (13.3%). Regarding living conditions, 99.2% of the schoolchildren had access to treated water, 94.6% said they had sewage collection and treatment in their households, and 99.2% reported having garbage collection. As to legal representatives' knowledge about parasitic infections, 74.7% knew what they were and 67.3% knew about their modes of transmission. However, 49.8% considered the information to be insufficient. Conclusions: This study revealed a low prevalence of parasitic infections in schoolchildren and favorable sanitation in their households. A high frequency of antiparasitic drug use without previous diagnosis by stool examination was reported.