Sand dam contributions to year-round water security monitored through telemetered handpump data.

Sand dams are a form of rainwater harvesting, prolific in arid and semi-arid lands. Water is provided partly via handpumps, which, as the only improved method of abstraction from sand dams, are important for drinking water security. Accelerometers and cellular transmitters were fitted to 30 handpumps by the Africa Sand Dam Foundation (ASDF) in 2019 to monitor the use and reliability of the handpumps by recording hourly water volume abstracted. Data from April 2019 to October 2021 for 26 of these sites, alongside qualitative data, were analysed and each handpump's contribution to year-round water security was explored, focusing on the long dry season when water supply from other sources is compromised. Abstraction was over 20 times higher in the long dry season than in any other season, and at sites with higher salinity, higher livestock use, and larger dam wall area. At 21 wells, abstraction was still being recorded at the end of at least one long dry season; however, high spatial and temporal heterogeneity between pumps and seasons means that not all sand dams deliver reliable water supply year-round. Quantifying the contribution that sand dams make to water security is crucial for understanding their resilience against a changing climate and can aid decision makers when choosing the most appropriate water management technique. Knowledge of temporal and site heterogeneity in abstraction can inform when other water sources need increasing and can help with sand dam design optimisation. Overall, our results indicate the positive contribution that sand dams make to year-round water security through the water that is abstracted through handpumps.

Efficacy of DigiKnowItNews: Teen, a multimedia educational website for adolescents about pediatric clinical trials: study protocol for a randomized controlled trial.

BACKGROUND: Pediatric research is crucial for the development of new scientific advancements, treatments, and therapies for adolescents. Yet relatively few pediatric clinical trials are conducted due to barriers to successful recruitment and retention, including knowledge and attitudes about clinical trials. Adolescents tend to experience greater autonomy to make decisions and have expressed interest in being part of the decision to participate in clinical trials. Increasing knowledge, positive attitudes, and self-efficacy related to clinical trials could positively impact the decision to participate in a pediatric clinical trial. However, there are currently few interactive, developmentally appropriate, web-based resources available to educate adolescents about clinical trials. DigiKnowItNews: Teen was created as a multimedia educational website to address the relatively low levels of enrollment in pediatric clinical trials and need for information to empower adolescents to make decisions about participating in clinical trials. METHODS: This is a parallel group randomized controlled superiority trial to test the effectiveness of DigiKnowItNews: Teen, for improving factors related to clinical trial participation among adolescent and parents. Eligible parent-adolescent (ages 12 to 17 years) pairs will be randomly assigned to one of two conditions: intervention or wait-list control. All participants will complete pre- and post-test questionnaires and participants assigned to the intervention will receive access to review the DigiKnowItNews: Teen content for 1 week. Wait-list control participants will have the option to review DigiKnowItNews: Teen after study completion. The primary outcomes are knowledge about clinical research, attitudes, and beliefs toward pediatric clinical trials, self-efficacy for making decisions related to clinical trial participation, willingness to participate in a future clinical trial, procedural fears, and parent-adolescent communication quality. Overall feedback and satisfaction related to DigiKnowItNews: Teen will also be collected. DISCUSSION: The trial will evaluate the effectiveness of DigiKnowIt News: Teen, an educational website about pediatric clinical trials for adolescents. If found effective in promoting factors related to future pediatric clinical trial participation, DigiKnowIt News: Teen could be used by adolescents, along with their parents, as they make the decision to participate in a clinical trial. Clinical trial researchers can also use DigiKnowIt News: Teen to aid their participant recruitment efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT05714943. Registered on 02/03/2023.

Sand dams for sustainable water management: Challenges and future opportunities.

Sand dams are impermeable water harvesting structures built to collect and store water within the volume of sediments transported by ephemeral rivers. The artificial sandy aquifer created by the sand dam reduces evaporation losses relative to surface water storage in traditional dams. Recent years have seen a renaissance of studies on sand dams as an effective water scarcity adaptation strategy for drylands. However, many aspects of their functioning and effectiveness are still unclear. Literature reviews have pointed to a range of research gaps that need further scientific attention, such as river corridors and network dynamics, watershed-scale impacts, and interaction with social dynamics. However, the scattered and partially incomplete information across the different reviews would benefit from an integrated framework for directing future research efforts. This paper is a collaborative effort of different research groups active on sand dams and stems from the need to channel future research efforts on this topic in a thorough and coherent way. We synthesize the pivotal research gaps of a) unclear definition of "functioning" sand dams, b) lack of methodologies for watershed-scale analysis, c) neglect of social aspects in sand dam research, and d) underreported impacts of sand dams. We then propose framing future research to better target the synthesized gaps, including using the social-ecological systems framework to better capture the interconnected social and biophysical research gaps on sand dams, fully utilizing the potential of remote sensing in large-scale studies and collecting sand dam cases across the world to create an extensive database to advance evidence-based research on sand dams.

Evaluation of a specialist antenatal nutrition clinic for women with a body mass index ≥ 40kg/m2: A qualitative study.

OBJECTIVE: To explore the views of women who attended a specialist antenatal nutrition clinic that was specifically developed and piloted for pregnant women with a BMI ≥ 40 kg/m2. DESIGN: A phenomenological approach, using individual interviews, was employed. Discussions were audio recorded, transcribed verbatim and scrutinised using Interpretive Phenomenological Analysis. Themes were pinpointed and supported with direct quotes to demonstrate results. SETTING AND PARTICIPANTS: Eight women, with a BMI ≥ 40 kg/m2, receiving antenatal care at a tertiary hospital in south eastern Australia and who participated in a specialist antenatal nutrition service were interviewed. FINDINGS: Three main themes emerged: 1) Motivation to be Healthy; 2) Woman Centred Nutrition Care; 3) Conflicts, Confusion and Assumptions. KEY CONCLUSIONS: Pregnant women with a BMI ≥ 40kgm2 responded positively to incorporating dietitians in the antenatal care setting. The reinforcement and reassurance provided by the specialist dietetic team was highly valued. More effective communication regarding referrals, improved consistency in information provided by the entire antenatal service and continuity of dietetic support beyond birth would add value to future interventions.

DigiKnowIt News: Educating youth about pediatric clinical trials using an interactive, multimedia educational website.

Pediatric clinical trials allow for the testing of appropriate and effective treatments for children. However, some challenges exist with recruitment. This study examined the effectiveness of DigiKnowIt News, an interactive, multimedia website (which includes activities, videos, and comic books) designed to educate children about clinical trials. A randomized controlled trial was conducted in 2018 with 91 participants (M age = 10.92 years; SD = 2.06). Participants were randomly assigned to intervention or wait-list control groups and completed questionnaires at pretest and posttest (1 week later) about their knowledge, attitudes, beliefs about clinical trials, and self-efficacy for participating in clinical trials. Participants in the intervention group received access to DigiKnowIt News between pretest and posttest and completed a satisfaction questionnaire at posttest. At the end of the study, participants in the wait-list control group were offered the option to use the website and complete a satisfaction questionnaire. At posttest, participants in the intervention group, compared to participants in the wait-list control group, had more knowledge about clinical trials and more reported confidence for participating in clinical trials. Participants reported high levels of satisfaction with DigiKnowIt News. The findings suggest that an educational website can improve factors related to increasing rates of participation in clinical trials.

A randomised controlled feasibility trial of a BabyWASH household playspace: The CAMPI study.

BACKGROUND: Water, sanitation and hygiene (WASH) interventions should support infant growth but trial results are inconsistent. Frequently, interventions do not consider behaviours or transmission pathways specific to age. A household playspace (HPS) is one intervention component which may block faecal-oral transmission. This study was a two-armed, parallel-group, randomised, controlled feasibility trial of a HPS in rural Ethiopia. It aimed to recommend proceeding to a definitive trial. Secondary outcomes included effects on infant health, injury prevention and women's time. METHODS: November 2019-January 2020 106 households were identified and assessed for eligibility. Recruited households (N = 100) were randomised (blinded prior to the trial start) to intervention or control (both n = 50). Outcomes included recruitment, attrition, adherence, and acceptability. Data were collected at baseline, two and four weeks. FINDINGS: Recruitment met a priori criteria (≥80%). There was no loss to follow-up, and no non-use, meeting adherence criteria (both ≤10%). Further, 48.0% (95% CI 33.7-62.6; n = 24) of households appropriately used and 56.0% (41.3-70.0; n = 28) cleaned the HPS over four weeks, partly meeting adherence criteria (≥50%). For acceptability, 41.0% (31.3-51.3; n = 41) of infants were in the HPS during random visits, failing criteria (≥50%). Further, the proportion of HPS use decreased during some activities, failing criteria (no decrease in use). A modified Barrier Analysis described good acceptability and multiple secondary benefits, including on women's time burden and infant injury prevention. INTERPRETATION: Despite failing some a priori criteria, the trial demonstrated mixed adherence and good acceptability among intervention households. A definitive trial to determine efficacy is warranted if recommended adjustments are made. FUNDING: People In Need; Czech Development Agency. TRIAL REGISTRATION: RIDIE-ID-5de0b6938afb8.

Multi-Sectoral Participatory Design of a BabyWASH Playspace for Rural Ethiopian Households.

Growing evidence suggests current water, sanitation, and hygiene interventions do not improve domestic hygiene sufficiently to improve infant health, nor consider the age-specific behaviors which increase infection risk. A household playspace (HPS) is described as one critical intervention to reduce direct fecal-oral transmission within formative growth periods. This article details both the design and development (materials and methods), and testing (results) of a HPS for rural Ethiopian households. Design and testing followed a multi-sectoral, multistep participatory process. This included a focus group discussion (FGD), two user-centered and participatory design workshops in the United Kingdom and Ethiopia, discussions with local manufacturers, and a Trials by Improved Practices (TIPs) leading to a final prototype design. Testing included the FGD and TIPs study and a subsequent randomized controlled feasibility trial in Ethiopian households. This multi-sectoral, multistage development process demonstrated a HPS is an acceptable and feasible intervention in these low-income, rural subsistence Ethiopian households. A HPS may help reduce fecal-oral transmission and infection-particularly in settings where free-range domestic livestock present an increased risk. With the need to better tailor interventions to improve infant health, this article also provides a framework for future groups developing similar material inputs and highlights the value of participatory design in this field.

A Qualitative Study of NIMBYism for Waste in Smaller Urban Areas of a Low-Income Country, Mzuzu, Malawi.

When waste management infrastructure is built, there can be resistance from the local affected populations, often termed the Not in My Backyard (NIMBY) phenomenon. This study aims to understand the forms of resistance that may develop in such contexts, focusing on 2 solid waste and 1 liquid waste management site within Mzuzu City, Malawi. At the newest solid waste site, community resistance had grown to the extent that the site was reportedly destroyed by the local community. Interviews and observations of the sites are complemented by examining historic and recent satellite images. It was found that, at the new solid waste site, community engagement had not been conducted effectively prior to construction and as part of ongoing site operations. This was compounded by poor site management and the non-delivery of the promised benefits to the community. In contrast, at the liquid waste site, the community could access untreated sludge for use as fertilizer and were happier to live within its vicinity. While NIMBYism is a frustrating phenomenon for city planners, it is understandable that communities want to protect their health and well-being when there is a history of mismanagement of waste sites which is sadly common in low-income settings. It is difficult for government agencies to deliver these services and broader waste management. In this study, an unsuccessful attempt to do something better with a legitimate goal is not necessarily a failure, but part of a natural learning process for getting things right.

Genetic Characterization of the Giant Liver Fluke, Fascioloides magna (Platyhelminthes: Fasciolidae) From the Adirondack Region of Northern New York.

PURPOSE: The giant liver fluke, Fascioloides magna, is an important parasite of white-tailed deer (Odocoileus virginanus), a commercially important game species in the northeastern United States. However, the parasite has never been genetically characterized from this region and so its genetic interrelationships with other enzootic populations on the continent are unknown. The purpose of this study was to genetically characterize F. magna from the Adirondack region of northern New York (NNY) and determine its relationship with its enzootic cohorts. METHODS: Flukes were extracted from seven livers of O. virginanus at three localities in and around the Adirondack Park in northern New York. DNA was extracted from eight individuals using standard procedures, and a 440-bp fragment of the COI gene was amplified using species-specific primers. F. magna sequences generated from a previous phylogeographic study were obtained from the GenBank database and a mtDNA dataset was compiled, aligned, and edited for molecular analyses. Analyses based on eight mtDNA sequences included haplotype network reconstruction, along with hierarchical and pairwise (ФST) AMOVA tests. RESULTS: F. magna from the Adirondacks was found to be most genetically similar to specimens from Minnesota based on shared haplotypes and relatively low genetic differentiation (ФST = 0.331). East coast enzootic populations exhibited panmixia while their west coast cohorts were genetically distinct. CONCLUSION: Based on the strong genetic similarities between F. magna from northern New York and Minnesota, we propose that the GLR enzootic range of F. magna be extended to encompass the Adirondack region of NNY.

Faeces - Urine separation via settling and displacement: Prototype tests for a novel non-sewered sanitation system.

The development of novel, non-sewered sanitation systems like the Nano Membrane Toilet requires thorough investigation of processes that may seem well-understood. For example, unlike the settling of primary sludge, the separation of solids from liquids in a small-volume container at the scale of a household toilet has not been studied before. In two sets of experiments, the settling of real faeces and toilet paper in settling columns and the settling of synthetic faeces in a conical tank are investigated to understand the factors affecting the liquid quality for downstream treatment processes. Toilet paper is found to be a major inhibitor to settling of solids. While a lower overflow point results in better phase separation through displacement of liquid, a higher overflow point and frequent removal of solids may be more advantageous for the liquid quality.

Whither regulation, risk and water safety plans? Case studies from Malaysia and from England and Wales.

We explore the interplay between preventative risk management and regulatory style for the implementation of water safety plans in Malaysia and in England and Wales, two jurisdictions with distinct philosophies of approach. Semi-structured interviews were conducted with 32 water safety professionals in Malaysia, 23 in England and Wales, supported by 6 Focus Group Discussions (n = 53 participants). A grounded theory approach produced insights on the transition from drinking water quality surveillance to preventative risk management. Themes familiar to this type of regulatory transition emerged, including concerns about compliance policy; overseeing the risk management controls of regulatees with varied competencies and funds available to drive change; and the portfolio of interventions suited to a more facilitative regulatory style. Because the potential harm from waterborne illness is high where pathogen exposures occur, the transition to risk-informed regulation demands mature organisational cultures among water utilities and regulators, and a laser-like focus on ensuring risk management controls are delivered within water supply systems.

Membrane distillation of concentrated blackwater: Effect of temperature, solids concentration and membrane pore size.

This study has elucidated the mechanisms governing water recovery from blackwater using membrane distillation, and has clarified the role of the organic particle fraction on membrane performance. Whilst fecal pathogen growth was initially observed at lower temperatures, pathogen inactivation was demonstrated over time, due to urea hydrolysis which liberated ammonia in excess of its toxic threshold. During the growth phase, membrane pore size <0.45 µm was sufficient to achieve high log reduction values for Escherichia coli, due to size exclusion complimented by the liquid-vapor interface which enhances selective transport for water. Higher feed temperatures benefitted rejection by promoting thermal inactivation and suppressing urea hydrolysis. Whilst the mechanism is not yet clear, suppression of hydrolysis reduced bicarbonate formation kinetics stabilizing the ammonia-ammonium equilibrium which improved ammonium rejection. Blackwater particle concentration was studied by increasing fecal content. Particle fouling improved selectivity for coarse pore membranes but increased mass transfer resistance which reduced flux. Particle fouling induced wetting as noted by an eventual breakthrough of feed into the permeate. We propose that by incorporating upstream solid-liquid separation for particle separation to limit wetting and mass transfer resistance, membrane distillation can be a reliable solution for the recovery of high-quality permeate from blackwater. PRACTITIONER POINTS: Membrane distillation demonstrated for concentrated blackwater. Multiple factors provide robust pathogen separation (pore size, vapor-liquid interface, temperature, free-ammonia). Excellent water quality produced for feed 40 times more concentrated than wastewater. Removing particle fraction will improve separation robustness and operating longevity.

Evaluating the circular economy for sanitation: Findings from a multi-case approach.

Addressing the lack of sanitation globally is a major global challenge with 700 million people still practicing open defecation. Circular Economy (CE) in the context of sanitation focuses on the whole sanitation chain which includes the provision of toilets, the collection of waste, treatment and transformation into sanitation-derived products including fertiliser, fuel and clean water. After a qualitative study from five case studies across India, covering different treatment technologies, waste-derived products, markets and contexts; this research identifies the main barriers and enablers for circular sanitation business models to succeed. A framework assessing the technical and social system changes required to enable circular sanitation models was derived from the case studies. Some of these changes can be achieved with increased enforcement, policies and subsidies for fertilisers, and integration of sanitation with other waste streams to increase its viability. Major changes such as the cultural norms around re-use, demographic shifts and soil depletion would be outside the scope of a single project, policy or planning initiative. The move to CE sanitation may still be desirable from a policy perspective but we argue that shifting to CE models should not be seen as a panacea that can solve the global sanitation crisis. Delivering the public good of safe sanitation services for all, whether circular or not, will continue to be a difficult task.

Risk factors and transmission pathways associated with infant Campylobacter spp. prevalence and malnutrition: A formative study in rural Ethiopia.

Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.

Do domestic animals contribute to bacterial contamination of infant transmission pathways? Formative evidence from Ethiopia.

Child stunting is associated with poor water, sanitation and hygiene (WASH), partly due to the effect of infection on intestinal nutrient absorption. WASH interventions, however, show little effect on growth. A hypothesis is that bacterial contamination of hands and floors from domestic animals and their faeces, and subsequent ingestion via infant hand-to-mouth behaviours, may explain this. This formative study used microbial testing and survey and observational data from 20 households in Ethiopia to characterise principle bacterial transmission pathways to infants, considering WASH facilities and practices, infant behaviours and animal exposure. Microbial swabbing showed the contamination of hands and floor surfaces from thermotolerant coliform bacteria. Animal husbandry practices, such as keeping animals inside, contributed significantly (all p < 0.005). There was no evidence that latrine facilities mitigated contamination across infant (p = 0.76) or maternal (p = 0.86) hands or floor surfaces (p = 0.36). This small study contributes to the evidence that animal faeces are an important source of domestic bacterial contamination. The results imply that interventions aiming to reduce pathogen transmission to infants should think beyond improving WASH and also consider the need to separate infants and animals in the home. Intervention studies will be required to determine whether this reduces infant infection and improves linear growth.

A framework for targeting water, sanitation and hygiene interventions in pastoralist populations in the Afar region of Ethiopia.

Globally, many populations face structural and environmental barriers to access safe water, sanitation and hygiene (WASH) services. Among these populations are many of the 200 million pastoralists whose livelihood patterns and extreme environmental settings challenge conventional WASH programming approaches. In this paper, we studied the Afar pastoralists in Ethiopia to identify WASH interventions that can mostly alleviate public health risks, within the population's structural and environmental living constraints. Surveys were carried out with 148 individuals and observational assessments made in 12 households as part of a Pastoralist Community WASH Risk Assessment. The results show that low levels of access to infrastructure are further compounded by risky behaviours related to water containment, storage and transportation. Additional behavioural risk factors were identified related to sanitation, hygiene and animal husbandry. The Pastoralist Community WASH Risk Assessment visually interprets the seriousness of the risks against the difficulty of addressing the problem. The assessment recommends interventions on household behaviours, environmental cleanliness, water storage, treatment and hand hygiene via small-scale educational interventions. The framework provides an approach for assessing risks in other marginal populations that are poorly understood and served through conventional approaches.

Field testing of a prototype mechanical dry toilet flush.

A prototype of a non-fluid based mechanical toilet flush was tested in a semi-public, institutional setting and in selected peri-urban households in eThekwini municipality, Republic of South Africa. The mechanism's functionality and users' perception of the flush were assessed. User perception varied depending on background: Users accustomed to porcelain water flush toilets were open to, yet reserved about the idea of using a waterless flush in their homes. Those who commonly use Urine Diversion Dehydration Toilets were far more receptive. The user-centred field trials were complemented by a controlled laboratory experiment, using synthetic urine, -faeces, and -menstrual blood, to systematically assess the efficiency of three swipe materials to clean the rotating bowl of the flush. A silicone rubber with oil-bleed-effect was found to be the best performing material for the swipe. Lubrication of the bowl prior to use further reduced fouling. A mechanical waterless flush that does not require consumables, like plastic wrappers, is a novelty and could - implemented in existing dry toilet systems - improve acceptance and thus the success of waterless sanitation.

Environmental enteric dysfunction and child stunting.

In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.

Planning and communicating prototype tests for the Nano Membrane Toilet: A critical review and proposed strategy.

Urban sanitation in growing cities of the Global South presents particular challenges. This led to the Bill & Melinda Gates Foundation's Reinvent The Toilet Challenge, which sparked the development of various non-sewered sanitation technologies like the Nano Membrane Toilet. Complex disruptive technologies like this entail an extensive product development process, including various types of prototype tests. While there is an abundance of literature discussing how to build prototypes, and the optimal number of tests, there has been little focus on how to plan and conduct tests, especially in a development endeavour of this complexity. Four approaches to testing are reviewed, and their strengths and weaknesses compared. A visualised testing strategy is proposed that encompasses the entire product development process and can be used to plan and communicate prototype tests for the Nano Membrane Toilet to ultimately achieve compliance with international standards.

Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries-A Review of the Literature.

Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems and the environment. Findings call for further research to gain better understandings of MHM waste streams, disposal behaviors, absorbent materials and waste management technologies to deliver health, safety, mobility and dignity for women and girls.