Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions.

INTRODUCTION: Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease. OBJECTIVE: Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access. METHODS: Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool. RESULTS: Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51-3.19, p < 0.05, I2 = 97.28), latrine usage (OR 3.72, 95% CI 1.71-8.11, p < 0.05, I2 = 91.52), latrine coverage or access (OR 3.95, 95% CI 2.08-7.50, p < 0.05, I2 = 99.07), and improved latrine coverage or access (OR 3.68, 95% CI 1.52-8.91, p < 0.05, I2 = 99.11). A combination of education and latrine construction was more effective compared to educational intervention alone. CONCLUSION: Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions

INTRODUCTION@#Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease.@*OBJECTIVE@#Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access.@*METHODS@#Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool.@*RESULTS@#Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51-3.19, p < 0.05, I@*CONCLUSION@#Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

Fecal Malodor Detection Using Low-Cost Electrochemical Sensors.

Technology innovation in sanitation is needed for the 4.2 billion people worldwide, lacking safely managed sanitation services. A major requirement for the adoption of these technologies is the management of malodor around toilet and treatment systems. There is an unmet need for a low-cost instrumented technology for detecting the onset of sanitation malodor and triggering corrective actions. This study combines sensory data with low-cost gas sensor data on malodor emanating from feces. The response of 10 commercial electrochemical gas sensors was collected alongside olfactometric measurements. Odor from fecal specimens at different relevant dilution as well as specimens with pleasant odors as a control were evaluated for a total of 64 responses. Several of the sensors responded positively to the fecal odor, with the formaldehyde, hydrogen sulfide, and ammonia sensors featuring the highest signal to noise ratio. A positive trend was observed between the sensors' responses and the concentration of the odorant and with odor intensity, but no clear correspondence with dilution to threshold (D/T) values was found. Selected sensors were responsive both above and below the intensity values used as the cutoff for offensive odor, suggesting the possibility of using those sensors to differentiate odor offensiveness based just on the magnitude of their response. The specificity of the sensors suggested that discrimination between the selected non-fecal and fecal odors was possible. This study demonstrates that some of the evaluated sensors could be used to assemble a low-cost malodor warning system.

Principais mensagens sobre água, Saneamento e higiene e COVID-19 Instituições responsáveis pelos serviços de água e saneamento (esgoto) / Recomendaciones clave de agua, saneamiento e higiene: COVID-19. Instituciones responsables de agua y saneamiento / Main messages on water, sanitation and hygiene and COVID-19 Institutions responsible for water and sanitation (sewage) services

Os responsáveis pelos serviços de água e saneamento têm um papel relevante na prevenção e controle do vírus causador da doença COVID-19, e é importante que o abastecimento de água, saneamento e higiene sejam gerenciados com segurança, garantindo o cumprimento das regulamentações nacionais. Recomenda-se ativar os mecanismos de coordenação entre os diferentes setores relacionados à água e saneamento, tais como: saúde, educação, habitação, meio ambiente, municípios, instituições governamentais e reguladoras, para facilitar ações conjuntas, oportunas e de maior impacto.

Los responsables de agua y saneamiento tienen un rol relevante en la prevención y control de COVID-19, por lo que es importante que los servicios de agua, saneamiento e higiene sean gestionados de forma segura, garantizando el cumplimiento de las normativas nacionales.

Recomendações importantes sobre água, saneamento e higiene COVID-19 na comunidade / Recomendaciones clave de agua, saneamiento e higiene: COVID-19 en la comunidad / Important recommendations on water, sanitation and hygiene COVID-19 in the community

Boas práticas com água, saneamento e higiene, em particular lavagem de mãos com sabão e água limpa, devem ser estritamente aplicadas e mantidas, pois são importantes barreiras adicionais para a transmissão do o vírus causador da doença COVID-19 e outras doenças infecciosas em geral (OMS, 2002).

Las mejores prácticas de agua, saneamiento e higiene, en particular el lavado de manos con jabón y agua limpia, deben aplicarse y mantenerse estrictamente, ya que constituyen una barrera adicional importante para la transmisión de COVID-19 y para la transmisión de enfermedades infecciosas en general (OMS, 2002).

Recomendações importantes sobre água, saneamento e higiene COVID-19. Estabelecimentos de saúde / Recomendaciones clave de agua, saneamiento e higiene: COVID-19. Establecimientos de salud / Important recommendations on water, sanitation and hygiene COVID - 19. Health facilities

As recomendações existentes sobre água, saneamento e higiene nos estabelecimentos de saúde são importantes para garantir o atendimento adequado ao paciente e proteger tanto pacientes quanto funcionários. Estas incluem: fornecimento suficiente de água potável segura para funcionários, cuidadores e pacientes, higiene pessoal, lavanderia e limpeza; banheiros adequados e acessíveis; gerenciamento seguro de dejetos, incluindo a manutenção das fezes e urina separados do contato humano, seu tratamento e descarte seguros no ambiente; higiene frequente das mãos usando a técnica adequada; limpeza e desinfecção periódica; e gerenciamento seguro de resíduos de saúde.

Las medidas recomendadas existentes de agua, saneamiento e higiene en entornos de atención médica son importantes para proporcionar una atención adecuada a los pacientes y proteger a los pacientes y al personal considerando: la provisión suficiente de agua potable segura para el personal, los cuidadores y los pacientes; la higiene personal; la lavandería y la limpieza.

Table Cleaning Task by Human Support Robot Using Deep Learning Technique.

This work presents a table cleaning and inspection method using a Human Support Robot (HSR) which can operate in a typical food court setting. The HSR is able to perform a cleanliness inspection and also clean the food litter on the table by implementing a deep learning technique and planner framework. A lightweight Deep Convolutional Neural Network (DCNN) has been proposed to recognize the food litter on top of the table. In addition, the planner framework was proposed to HSR for accomplishing the table cleaning task which generates the cleaning path according to the detection of food litter and then the cleaning action is carried out. The effectiveness of the food litter detection module is verified with the cleanliness inspection task using Toyota HSR, and its detection results are verified with standard quality metrics. The experimental results show that the food litter detection module achieves an average of 96 % detection accuracy, which is more suitable for deploying the HSR robots for performing the cleanliness inspection and also helps to select the different cleaning modes. Further, the planner part has been tested through the table cleaning tasks. The experimental results show that the planner generated the cleaning path in real time and its generated path is optimal which reduces the cleaning time by grouping based cleaning action for removing the food litters from the table.

Fumigating the Hygienic Model City: Bubonic Plague and the Sulfurozador in Early-Twentieth-Century Buenos Aires.

The 1899/1900 arrival of bubonic plague in Argentina had thrown the model status of Buenos Aires as a hygienic city into crisis. Where the idea of foreign threats and imported epidemics had dominated the thinking of Argentina's sanitarians at that time, plague renewed concerns about hidden threats within the fabric of the capital's dense environment; concerns that led to new sanitary measures and unprecedented rat-campaigns supported by the large-scale application of sulphur dioxide. The article tells the story of early twentieth-century urban sanitation in Buenos Aires through the lens of a new industrial disinfection apparatus. The Aparato Marot, also known as Sulfurozador was acquired and integrated in the capital's sanitary administration by the epidemiologist José Penna in 1906 to materialise two key lessons learned from plague. First, the machine was supposed to translate the successful disinfection practices of global maritime sanitation into urban epidemic control in Argentina. Second, the machine's design enabled public health authorities to reinvigorate a traditional hygienic concern for the entirety of the city's terrain. While the Sulfurozador offered effective destruction of rats, it promised also a comprehensive - and utopian - disinfection of the whole city, freeing it from all imaginable pathogens, insects as well as rodents. In 1910, the successful introduction of the Sulfurozador encouraged Argentina's medico-political elite to introduce a new principle of 'general prophylaxis'. This article places the apparatus as a technological modernisation of traditional sanitary practices in the bacteriological age, which preserved the urban environment - 'el terreno' - as a principal site of intervention. Thus, the Sulfurozador allowed the 'higienistas' to sustain a long-standing utopian vision of all-encompassing social, bodily and political hygiene into the twentieth century.

A Community-Designed Play-Yard Intervention to Prevent Microbial Ingestion: A Baby Water, Sanitation, and Hygiene Pilot Study in Rural Zambia.

Malnourished children in low-income contexts usually suffer from environmental enteric dysfunction, which is damage to the intestines caused by chronic exposure to bacterial pathogens from feces hypothesized to contribute to stunting. Many intervention studies are piloting "Baby water, sanitation, and hygiene (WASH)" to help rural farming families reduce infant and young children's (IYC's) exposure to human and free-range livestock feces. One proposed Baby WASH intervention is a play-yard, which consists of a baby-proofed structure (i.e., playpen) that caregivers can place IYC into while doing chores around the household yard. This article describes the pilot development and assessment of a community-built Baby WASH play-yard and a plastic play-yard intervention with 21 caregivers of 6- to 24-month-old IYC in rural Zambia. A modified Trials of Improved Practices approach was used to conduct three visits in each household: an introductory visit during which play-yard use was explained, a second visit consisting of a semi-structured interview and a session of behavioral counseling, and a final visit which included a 2-hour observation of play-yard use. The second and final visits also included 24-hour recalls, and all three visits included spot observations of play-yard use. Reports from caregivers suggest that the community-built play-yard protected IYC from ingesting soil and livestock feces. Barriers to intervention use included caregivers' WASH beliefs and practices, community reactions, and play-yard maintenance. More work is needed to examine the role of women's time use in their home environment, community reactions to the intervention, and the biological efficacy to reduce microbial ingestion.

A 100-Year Review: A century of dairy processing advancements-Pasteurization, cleaning and sanitation, and sanitary equipment design.

Over the past century, advancements within the mainstream dairy foods processing industry have acted in complement with other dairy-affiliated industries to produce a human food that has few rivals with regard to safety, nutrition, and sustainability. These advancements, such as milk pasteurization, may appear commonplace in the context of a modern dairy processing plant, but some consideration of how these advancements came into being serve as a basis for considering what advancements will come to bear on the next century of processing advancements. In the year 1917, depending on where one resided, most milk was presented to the consumer through privately owned dairy animals, small local or regional dairy farms, or small urban commercial dairies with minimal, or at best nascent, processing capabilities. In 1917, much of the retail milk in the United States was packaged and sold in returnable quart-sized clear glass bottles fitted with caps of various design and composition. Some reports suggest that the cost of that quart of milk was approximately 9 cents-an estimated $2.00 in 2017 US dollars. Comparing that 1917 quart of milk to a quart of milk in 2017 suggests several differences in microbiological, compositional, and nutritional value as well as flavor characteristics. Although a more comprehensive timeline of significant processing advancements is noted in the AppendixTable A1 to this paper, we have selected 3 advancements to highlight; namely, the development of milk pasteurization, cleaning and sanitizing technologies, and sanitary specifications for processing equipment. Finally, we provide some insights into the future of milk processing and suggest areas where technological advancements may need continued or strengthened attention and development as a means of securing milk as a food of high safety and value for the next century to come.

Switching to sanitation: Understanding latrine adoption in a representative panel of rural Indian households.

Open defecation, which is still practiced by about a billion people worldwide, is one of the most compelling examples of how place influences health in developing countries. Efforts by governments and development organizations to address the world's remaining open defecation would be greatly supported by a better understanding of why some people adopt latrines and others do not. We analyze the 2005 and 2012 rounds of the India Human Development Survey (IHDS), a nationally representative panel of households in India, the country which is home to 60% of the people worldwide who defecate in the open. Among rural households that defecated in the open in 2005, we investigate what baseline properties and what changes over time are associated with switching to latrine use between 2005 and 2012. We find that households that are richer or better educated, that have certain demographic properties, or that improved their homes over this period were more likely to switch to using a latrine or toilet. However, each of these effect sizes is small; overall switching to latrine use from open defecation is low; and no ready household-level mechanisms are available for sanitation programs to widely influence these factors. Our research adds to a growing consensus in the literature that the social context should not be overlooked when trying to understand and bring about change in sanitation behavior.

VIM-Klebsiella oxytoca outbreak in a Neonatal Intensive Care Unit. This time it wasn't the drain.

OBJECTIVE: We describe an outbreak of VIM-carbapenemase Klebsiella oxytoca (VIM-Kox) in a NICU. MATERIALS AND METHODS: Prospective Epidemiological Surveillance:Systematically (weekly screening cultures) or on admission, if the patient had a history of previous colonization by VIM-Kox.Clinical cultures, done if infection was suspected.Other possible microorganism sources were investigated: their mothers (rectal microbiota), milk packages and preparation apparata in the lactodietary section, echocardiagram transductors, cribs, the sinks (faucets and drains), washing bowls, etc.Molecular typing was performed using the DiversiLab (bioMérieux) system on all VIM-Kox isolated from environment or patients (one by neonate). RESULTS: We identified 20 VIM-Kox cases, the most only presented colonization, but 4 showed infection. Three of the ten sinks (drains) in our NICU, were positive for VIM-Kox. Another four drains harbored P.aeruginosa, S. maltophilia and/or Enterobacter sp. Nevertheless the VIM-Kox bacteria in the sinks (drains) were not the same as those in the patients, who showed three different strains. CONCLUSIONS: A VIM-Kox colonization or infection outbreak in a NICU is described. Rather than environment, not even drains, the source of the outbreak was other patients. The outbreak was relatively brief, as a result of the rapidness with which appropriate measures were taken and followed.

Assessment of rock wool as support material for on-site sanitation: hydrodynamic and mechanical characterization.

This study proposes mechanical and hydrodynamic characterization of rock wool used as support material in compact filter. A double-pronged approach, based on experimental simulation of various physical states of this material was done. First of all a scanning electron microscopy observation allows to highlight the fibrous network structure, the fibres sizing distribution and the atomic absorption spectrum. The material was essentially lacunar with 97 ± 2% of void space. Static compression tests on variably saturated rock wool samples provide the fact that the strain/stress behaviours depend on both the sample conditioning and the saturation level. Results showed that water exerts plastifying effect on mechanical behaviour of rock wool. The load-displacement curves and drainage evolution under different water saturation levels allowed exhibiting hydraulic retention capacities under stress. Finally, several tracer experiments on rock wool column considering continuous and batch feeding flow regime allowed: (i) to determine the flow model for each test case and the implications for water dynamic in rock wool medium, (ii) to assess the rock wool double porosity and discuss its advantages for wastewater treatment, (iii) to analyse the benefits effect for water treatment when the high level of rock wool hydric retention was associated with the plug-flow effect, and (iv) to discuss the practical contributions for compact filter conception and management.

Pit latrine emptying behavior and demand for sanitation services in Dar Es Salaam, Tanzania.

Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar), Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines. A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like 'flooding out'. We measured strong interest in and willingness to pay (WTP) for the new pit emptying service at 96% of residences; 57% were WTP≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed.

Sensitivity analysis of the CLARA Simplified Planning Tool using the Morris screening method.

The Morris screening sensitivity analysis (SA) has been used to assess how the uncertainty of input parameters influences the output of the CLARA Simplified Planning Tool (CLARA-SPT). To assess the sensitivity of the tool, four hypothetical waste collection and treatment alternatives, which planned to serve 10,000 people, have been proposed and analysed. These alternatives are (A1) dry sanitation with urine diversion dry toilets (UDDTs), (A2) water-aided sanitation with decentralised treatment units, (A3) water-aided sanitation with central technical treatment and (A4) water-aided sanitation with cesspits. The SA was used to identify the influence of two global and 29 technological input parameters on lifetime costs and residual values of sanitation alternatives. The top two important parameters identified for each alternative are: 'type of urine transport' and 'persons using one UDDT' for alternative A1, 'persons served per septic tank' and 'required surface area for vertical flow constructed wetland' for alternative A2, 'daily diesel generator working hours' and 'expected annual growth' for alternative A3 and 'cesspit volume' and 'expected annual growth' for alternative A4. Additionally, the Morris SA identified non-linearity and/or parameter interaction response. The SA of the specified alternatives shows that from the 29 technological parameters investigated, a subset of 14 important parameters need estimates that are more accurate, whereas a subset of 15 non-influential parameters can be fixed to a certain value. In particular, two parameters (i.e. cesspit volume and persons using one UDDT) that have been internally fixed in the SPT were found to be important and thus should be made available as input parameters to the user. Overall, the study provides guidance for further modification and simplification of the CLARA-SPT.

Norovirus and rotavirus survival in urine collected from a public ecological sanitation system in Ouagadougou, Burkina Faso.

Urine from urine-diversion toilets (UDTs) is routinely used as fertilizer for urban agriculture in Ouagadougou, Burkina Faso. Because urine from UDTs can be accidentally spoiled by feces, we determined whether virulent enteric viruses could persist in urine that is used for agricultural purposes and pose a threat to human health. Urine samples (N = 60) were first collected from 42 UDTs during the months of January and February 2012 in Ouagadougou and screened negative for the presence of norovirus (NoV) and group A rotavirus (RV). Composite urine from five collection sites was used to determine whether spiked murine norovirus (MNV) and group A bovine rotavirus (boRVA) could remain infectious at 15, 25, and 42 °C over an incubation period of 42 days in phosphate buffered saline (control) and urine. For both viruses, infectivity was determined by plaque assay and the presence of viral genome was evaluated by real-time RT-PCR. A decrease in the infectious titer was observed in composite urines that were experimentally seeded with MNV and boRVA. The decrease in the infectious titer was greater for MNV than for boRVA. Given that MNV was more labile to urine than boRVA was, MNV and boRVA genomes were still detectable after the 42 and 49 days incubation period for MNV and boRVA, respectively. Our data using substitutes of human NoV and RV suggested that there is a virucidal activity of urine against RVs and NoVs, given that the effect was lesser for RV. In spite of disappointing results for boRVA, the use of urine as fertilizer is still promising provided that future safety studies are extended to other enteric viruses.

Cleaning and sanitation of Salmonella-contaminated peanut butter processing equipment.

Microbial contamination of peanut butter by Salmonella poses a significant health risk as Salmonella may remain viable throughout the product shelf life. Effective cleaning and sanitation of processing lines are essential for preventing cross-contamination. The objective of this study was to evaluate the efficacy of a cleaning and sanitation procedure involving hot oil and 60% isopropanol, ± quaternary ammonium compounds, to decontaminate pilot-scale processing equipment harboring Salmonella. Peanut butter inoculated with a cocktail of four Salmonella serovars (∼ 7 log CFU/g) was used to contaminate the equipment (∼ 75 L). The system was then emptied of peanut butter and treated with hot oil (90 °C) for 2 h followed by sanitizer for 1 h. Microbial analysis of food-contact surfaces (7 locations), peanut butter, and oil were conducted. Oil contained ∼ 3.2 log CFU/mL on both trypticase soy agar with yeast extract (TSAYE) and xylose lysine deoxycholate (XLD), indicating hot oil alone was not sufficient to inactivate Salmonella. Environmental sampling found 0.25-1.12 log CFU/cm(2) remaining on processing equipment. After the isopropanol sanitation (± quaternary ammonium compounds), no Salmonella was detected in environmental samples on XLD (<0.16 log CFU/cm(2)). These data suggest that a two-step hot oil clean and isopropanol sanitization treatment may eliminate pathogenic Salmonella from contaminated equipment.

The sanitation ladder, what constitutes an improved form of sanitation?

This study aimed to assess whether the MDG classifications and JMP sanitation ladder corresponded to hygienic proxies. Latrines were purposefully sampled in urban and rural Tanzania. Three hygienic proxies were measured: E. coli on points of hand contact, helminth at point of foot contact, and number of flies. Additionally, samples were collected from comparable surfaces in the household, and a questionnaire on management and use, combined with a visual inspection of the latrine's design was conducted. In total, 341 latrines were sampled. The MDG classifications "improved" vs "unimproved" did not describe the observed differences in E. coli concentrations. Disaggregating the data into the JMP sanitation ladder, on average "shared" facilities were the least contaminated: 9.2 vs 17.7 ("improved") and 137 E. coli/100 mL ("unimproved") (p = 0.04, p < 0.001). Logistic regression analysis suggests that both the presence of a slab and sharing a facility is protective against faecal-oral exposure (OR 0.18 95% CI 0.10, 0.34 and OR 0.52, 95% CI 0.29, 0.92). The findings do not support the current assumption that shared facilities of an adequate technology should be classified for MDG purposes as "unimproved".

Randomized crossover study evaluating the effect of a hand sanitizer dispenser on the frequency of hand hygiene among anesthesiology staff in the operating room.

Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers.