Inadequate Sanitation Facilities Research Articles

Sanitation Practices and Policies in India: Exploring Determinants and their Interlinkages

India, one of the emerging economies of the world, is plagued with preva-lence of inadequate and poor sanitation facilities. Unhealthy hygiene practices and menace of open defecation still persist in the country which seeks to be counted as one of the superpowers. While some of the poor countries of the world fare better than India in terms of sanitation, it becomes essential to look beyond economic factors to understand the problem. The problems are manifold and appear in many dimensions. While sixty percent of popula-tion does not have access to toilet facilities, the instances of non-utilisation of existing toilet facilities are also reported. The non-utilisation of existing toilet facilities may range from planning related concerns to attitudinal issues. The planning or policy related concerns stem from problems related to maintenance of toilets, lack of plumbing and drainage facilities, lack of water and sewage systems etc. To understand these problems and the efforts to address them, critical evaluation of sanitation policies is needed. Sanitation policies and perceptions of masses towards sanitation practices can be complementary factors for cost of access to sanitation facilities. This paper seeks to look into the factors affecting inadequate sanitation facilities from a broader point of view focussing on policy and practices. The paper utilises secondary sources and a case study to unravel the factors and their interlinkages.

English

The advent of urbanization and its concomitant increase in urban population has catapulted the street food industry into a crucial role in meeting the food demands of urban residents. Health experts however, have continued with the argument that numerous health hazards are associated with these street vended foods. This paper explores safety and hygiene status of urban street vended foods in Ho which has traces as an urban community being the Volta Regional capital 0town in Ghana. Data was sourced from the street food vendors, customers and key personalities at the forefront of Public and Environmental Health making use of both simple random and purposive sampling techniques. Semi structured questionnaires; in depth interviews (IDI) and personal observation were employed in data collection. In all, one hundred (100) respondents participated in the study. The analysis revealed that majority of the street vended foods in Ho was only partially safe for human consumption. Poor construction and location of vending sites, inadequate sanitary facilities, poor personal hygiene, temperature abuses and sub-standard packaging were identified as the main variables responsible for the low safety and quality of the street foods. The paper recommends that the Asogli Traditional Council, Ho Municipal Assembly, the Ghana Tourism Authority and civil society organizations should help regulate the activities of street food vendors by enforcing codes of practice for the street food business. Workshops and talk shows should be considered in order to expose food vendors to basic hygiene and sanitary practices necessary for food handling and preparation to promote food hygiene, sanitation and safety. Key words: Food vendors, safety, street food, quality.

Riverbed sediments in the Apies River, South Africa: recommending the use of both Clostridium perfringens and Escherichia coli as indicators of faecal pollution

Sediments have been shown to contribute to the microbial quality of the water column during resuspension and serve as reservoirs for potentially pathogenic organisms. Currently, definitive guidelines regarding microbial indicators that need to be assessed in order to monitor faecal pollution in sediments do not exist. In this study, Escherichia coli (a well-established indicator) and Clostridium perfringens were monitored to determine their suitability as indicators for faecal pollution of sediments. Enumeration of E. coli in water was performed using the ColilertTM 18/Quantitray-2000 system from IDEXX. Identification and enumeration of C. perfringens in water was conducted using the boil method followed by the pour plate technique. Real-time polymerase chain reaction (RT-PCR) was used to confirm isolates. E. coli and C. perfringens were enumerated in sediment by firstly using the water displacement approach to dislodge organisms from sediment and then subsequently followed by the same methods as those used for detection and enumeration of the two potential indicators in water. The highest concentrations of E. coli and C. perfringens were obtained along the main stem of the Apies River which was characterised by the presence of wastewater treatment works, animal farmlands and informal settlements with inadequate sanitary facilities. The lowest concentration of both organisms was observed along the tributaries of the river, where there was minimal faecal pollution-related activity. Due to the difference in biological characteristics and survival patterns, concentrations of E. coli in sediments fluctuated (higher concentrations in the wet season) during the entire sampling period while concentrations of C. perfringens remained stable. There was a positive correlation between temperature and the presence of both organisms in the sediment, indicating the enabling environment of sediment to aid in bacterial survival. E. coli and C. perfringens are both suitable indicators of faecal pollution in riverbed sediments. However, both organisms need to be monitored together for accurate assessment of the faecal pollution of sediments. E. coli remains a good indicator of recent faecal pollution and provides insight into the short-term impact of faecal pollution, while C. perfringens gives an indication of the long-term impact of faecal deposition in riverbed sediments due to the organisms’ persistence in the environment.

The Relationship between Inadequate Sanitation Facilities and the Economic Well-Being of Women in India

The present study attempts to ascertain the relationship between inadequate sanitation facilities and two key measures of the economic well-being of women in India: literacy rates and labor force participation rates. A two-stage regression model and correlation analysis are employed. All data is district-level for the year 2011. Results from a simple correlation analysis suggest that there is a positive correlation between latrine availability and female literacy rate but a negative correlation between latrines and the female labor force participation rate. Results from a twostage analysis, however, indicates that latrine availability is positively related to both female labor force participation and female literacy rates. These results suggest that the availability of latrines positively impacts the economic well-being of women. This is one of the first studies that examines the relationships between latrine availability and female labor force participation and literacy rates in India, and this is one of the few studies on this topic to use district-level data. Hence, these results are significant and suggest that the government of India should invest more in proper sanitation facilities for all of its citizens. These types of investments would greatly improve the economic lives of India’s women.

Access to improved sanitation facilities in low-income informal settlements of East African cities

Throughout Africa, the population in urban areas is increasing rapidly, often exceeding the capacity and the resources of the cities and towns to accommodate the people. In sub-Saharan Africa, the majority of urban dwellers live in informal settlements served by inadequate sanitation facilities. These settlements present unique challenges to the provision of sustainable and hygienic sanitation, and there is insufficient information on access to improved facilities. This paper reports findings of a study undertaken in low-income informal settlements using a mixed methods approach to assess access to sanitation and identify the barriers to household uptake of improved sanitation facilities. More than half of the respondents (59.7%) reported using sanitation facilities that are included in the WHO/UNICEF Joint Monitoring Programme definition of improved sanitation. However, a high proportion of these facilities did not provide access to basic sanitation. Less than 5% of all the respondents did not report problems related to sustainable access to basic sanitation. The findings highlight the urgent need to develop specific and strategic interventions for each low-income informal settlement, to upscale the sustainable access and use of improved sanitation in urban centres.

English

BACKGROUND: Menstruation has often been dealt with secrecy in many cultures. Such perceptions coupled with poor and inadequate sanitary facilities have often kept girls from not attending schools especially during periods of menstruation. There is gross lack of information on menstrual management among adolescent girls; most of these girls seek information about menstruation from their peers who do not know better. Adolescence being a time of tremendous opportunity, and at the same time also a time of heightened vulnerabilities, it is imperative to empower adolescent girls with adequate information and skills on crucial issues like menstrual hygiene and its management. AIM: To know the knowledge and menstrual hygiene practices of adolescent girls. MATERIAL & METHODS: Across sectional study was conducted among 210 adolescent girls in a rural field practice area of Rajarajeswari Medical College & Hospital. Data on socio-economic variables and menstrual characteristics were collected using pre-tested questionnaires. RESULTS: 87.6% of the girls were aware about menstruation prior to the attainment of menarche. Mothers were the first informants in about 56.5% girls. Overall 51.5% adolescent girls were using sanitary napkins as menstrual absorbent, while 45.6% were using used cloths. Regarding practices, for cleaning of used cloths 88.9% girls used both soap and water. Regarding restrictions practiced, 97.6% girls practiced different restrictions during menstruation. CONCLUSION: There is a need to educate the girls about menstruation, its importance and hygiene maintenance; so as to enable them to lead a healthy reproductive life in future.

Dispatches

Dispatches

A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia

The barriers to menstrual hygiene management faced by adolescent schoolgirls in low-income countries are gaining interest at practice and policy levels. The challenges include inadequate water, sanitation and disposal facilities for the management of menses with privacy and dignity, and insufficient guidance to help girls feel confident in attending school during menses. The studies described here aimed to examine how menarche impacts the lives of schoolgirls in three low-income countries (Ghana, Cambodia and Ethiopia). The focus included girls’ school participation; their relationship with parents, teachers and peers; their evolving sanitation and hygiene needs; their understanding of cultural issues and taboos around menses; and what education, if any, they received prior to and during puberty. This comparative analysis was aimed at identifying similarities between the three countries that would enable the adaptation to each context of a training book on menstruation issues for girls, which was developed from a previous study conducted in Tanzania. In all three countries, participatory activities were utilised with girls and results were analysed using grounded theory. Findings included: similarities regarding the importance of culture in perpetuating negative attitudes towards menstruation, limited provision of health information and insufficient facilities within schools. Differences were revealed regarding menstrual myths, parent–child dynamics, sources of guidance and student–teacher relations. There is a critical knowledge gap around menstruation and girls’ education in these contexts that must be addressed to ensure that girls experience a positive menarche and can manage menstrual hygiene.

An assessment of effectiveness of the Lunyangwa River catchment co-management model in Mzuzu City, Northern Malawi

An assessment of the effectiveness of Lunyangwa River catchment co-management model in Mzuzu City, Northern Malawi has been carried out. This study was aimed at assessing the effectiveness of the approach in boosting Northern Region Water Board’s (NRWB) water production capacities and simultaneously addressing water quality challenges facing NRWB. A questionnaire survey was carried out to elicit information pertaining to formation and implementation of the approach. The results of the survey were analysed to assess the strengths and weaknesses of management policies and programs, from the perspective of catchment co-management. Literature was reviewed to form a conceptual framework for the investigation of the effectiveness of catchment co-management. Direct observations were also done to collect data on the physical attributes of the catchment area. Water samples were collected from 54 sites using standard sampling procedures and analysed for pH, EC, TDS, turbidity and faecal coliform count using standard methods. The study revealed that there was a quest to empower and improve the capacity of grass-root level community members to participate effectively in co-management decision making. However, it was observed that regardless of season, the population-poverty-environment nexus is negatively affecting the implementation of the co-management approach. The nexus has led to degradation of trees for community livelihoods, which results in increased levels of silt loads that increases turbidity in Lunyangwa River catchment and Gulliver dam (turbidity range=130–225 NTU). The high turbidity levels led to increase in the amount of coagulant dose used to treat raw water. Raw water of turbidity levels higher than 200 NTU used a coagulant dose of about 7.5mg/ℓ, which is higher than a 0.5mg/ℓ coagulant dose that was being used before high turbidity problems. In addition, inadequate sanitary facilities for human settlements, particularly those established in upper Lunyangwa River catchment area also contributed to the deterioration of the microbial quality of water in Lunyangwa River catchment and dam (faecal coliform>1000counts/mℓ). The water from Lunyangwa River could be classified as freshwater (TDS<1000mg/ℓ) which registered a uniformly fair water quality rating (WQI range=33.12–35.03%). The water levels in Gulliver dam were also observed to have been going down. A collaborative and systems approach is suggested for sustainable management of freshwater resources in Lunyangwa River catchment area since co-management is a novel approach and might require more effort to be understood by grass-root level community and stakeholders.

Cambodian girls' recommendations for facilitating menstrual hygiene management in school

Inadequate school water and sanitation facilities in many low-income countries, including Cambodia, are problematic for pubescent girls as they reach menarche and must subsequently manage monthly menses while attending school. This comparative case study explored girls' own suggestions for improving the pubertal guidance they receive in the classroom, and for modifications of existing school water, sanitation and hygiene (WASH) facilities in order to better meet schoolgirls' menstrual hygiene management needs. Key findings included girls' recommendations for teaching methodologies that encourage questions and practical content regarding puberty and menstrual management before the onset of menarche, and WASH-specific recommendations for the increased availability of water and sanitary materials in toilet stalls and greater privacy from boys and other girls. Incorporating girls' recommendations into WASH, health and education related policy and programming in low-income countries would allow girls to comfortably and confidently manage menses within the school environment.

Overcoming the Taboo: Advancing the Global Agenda for Menstrual Hygiene Management for Schoolgirls

INADEQUATE WATER AND sanitation facilities pose a major impediment to school-going girls during menstruation, compromising their ability to maintain proper hygiene and privacy. A growing focus on menstrual hygiene management (MHM) from nongovernmental organizations, the United Nations Children’s Fund (UNICEF), and other international agencies now highlights the profound impact of this problem on school-aged girls and provides the basis for a much needed research, programming, and policy agenda.

Water and sanitation in schools: a systematic review of the health and educational outcomes.

A systematic review of the literature on the effects of water and sanitation in schools was performed. The goal was to characterize the impacts of water and sanitation inadequacies in the academic environment. Published peer reviewed literature was screened and articles that documented the provision of water and sanitation at schools were considered. Forty-one peer-reviewed papers met the criteria of exploring the effects of the availability of water and/or sanitation facilities in educational establishments. Chosen studies were divided into six fields based on their specific foci: water for drinking, water for handwashing, water for drinking and handwashing, water for sanitation, sanitation for menstruation and combined water and sanitation. The studies provide evidence for an increase in water intake with increased provision of water and increased access to water facilities. Articles also report an increase in absenteeism from schools in developing countries during menses due to inadequate sanitation facilities. Lastly, there is a reported decrease in diarrheal and gastrointestinal diseases with increased access to adequate sanitation facilities in schools. Ensuring ready access to safe drinking water, and hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health. Additional studies that examine the relationship between sanitation provisions in schools are needed to more adequately characterize the impact of water and sanitation on educational achievements.

Self-rated resilience among young migrants in old Fadama, Accra, Ghana

A number of young people from the north of Ghana migrate to live in the slums of the city of Accra, the administrative capital. These slums, characterized by poor quality housing, and inadequate sanitary facilities, make the young migrants vulnerable to the effects of economic, social, political and environmental insecurities and stressors. One of such slums is Old Fadama, which is located in the heart of the city. The main objective of this paper is to explain how resilient a sample of young migrants are to the stressors encountered at the slum through a self-rated level of resilience. Drawing on resilience thinking, the Youth Resilience Framework and Social Resilience perspectives are discussed and variables for analysis are considered from their synthesis. A survey questionnaire instrument is used to collect data from 104 young migrant residents in the slum. The methods of analysis include: analyses of variance, Chi-square test, and ordinal regression. From the multivariate analyses (that is, the ordinal regression analyses), it is suggested that significant predictors of resilience among the sampled young migrants in Old Fadama include type of employment, social capital, number of stressors experienced, and ability to afford medicine. Specific social capital constructs such as having a boy or girlfriend and strong leadership are predictors of resilience among these young migrants in the slum.

A review of wastewater handling in the Arctic with special reference to pharmaceuticals and personal care products (PPCPs) and microbial pollution

Treatment of wastewater is often inadequate or completely lacking in Arctic regions. Wastewater contains different kinds of substances that can be harmful for the environment and human health, including residues of pharmaceuticals and personal care products. Bioaccumulation and biomagnifications of chemicals in the food web are of concern. This can affect fishery that is a significant industry in many Arctic coastal regions. Wastewater from human settlements may also contain antibiotic resistant bacteria and pathogens that can cause negative impacts on human health and the environment. In the Arctic, especially, the direct release of untreated sewage may have severe consequences for the receiving environment due to low biological diversity, low ambient temperatures and consequently high vulnerability of the Arctic ecosystem to environmental contaminants.Bucket toilets are common in remote settlements but are also used in towns. In settlements having inadequate sanitary facilities the risk of contracting diseases, such as hepatitis A, is unacceptably high. Conventional centralized wastewater collection systems and treatment plants are a challenge to build in the Arctic and expensive to operate. Thus alternative methods are needed. Possible solutions are improved dry or low flush toilets with collection of toilet waste at the household level and subsequent centralized treatment by dry composting or anaerobic digestion. Both treatment methods facilitate co-treatment of wastewater along with other organic waste fractions and provide a by-product that is environmentally safe and easy to handle. Combining the above with decentralized greywater treatment will reduce the costs for expensive infrastructure.

Microbial Ecology and Global Health

Microbial Ecology and Global Health

Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.

BackgroundAs a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world's fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania.Methodology/Principal FindingsCholera incidence was examined in relation to the percentage of a ward's residents who were informal, the percentage of a ward's informal residents without an improved water source, the percentage of a ward's informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km2 in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest.Conclusions/SignificanceOur results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world's urban population continues to expand.

SWOT analysis: The analytical method in the process of planning and its application in the development of orthopaedic hospital department

SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department capacities, inadequate nutrition, low opportunities for expert training of the personnel, outdated equipment, and presence of informal payments. SWOT analysis is a frequently used managerial instrument, which enables the systematic approach in decision making process.

Women, Water Management, and Health1

omen play a major role in domestic water management in areas where safe water and drainage are not available in the house. In these settings, women are typically responsible for collecting, storing, and using water and for disposing of wastewater (1,2). Most studies of women’s water management and the health benefits of safe water and sanitation examine the effect of protected water sources, such as covered wells or pumps, and basic sanitation (3). However, water management may also be a health issue in large villages and periurban communities that are supplied with piped water but have inadequate sanitation or drainage facilities. For example, in Egypt’s Nile Delta, tap water is available in most rural communities (although not in every house), and no absolute shortage of water exists. However, safely disposing of wastewater and toilet effluent often remains a problem; this problem is exacerbated by the high water table associated with the irrigation system. We conducted a study on Schistosoma mansoni in two Nile Delta villages (each with a population of ≈8,000) from 1991 to 1998. During this period, villagers risked infection with S. mansoni when they came into contact with water in irrigation canals; women were especially at risk when washing laundry and utensils in the canal. In our 1992 survey, both study villages had access to piped water; 78% of households in al-Garda and 39% in alSalamuniya had household connections. Al-Garda village had a pipeborne sewage system, but only one third of households were connected to it. Although 98% of households in al-Garda and 94% in al-Salamuniya had toilets, many of those households not connected to the sewage system did not safely dispose of effluent. In some cases, effluent in sewage vaults contaminated the subsoil water, and 25% of the toilets in al-Garda and 65% of these in alSalamuniya had to be emptied periodically, usually with a bucket. A few toilets in both villages illegally emptied directly into a canal or drain. Unsafe disposal of latrine effluent was implicated in schistosomiasis transmission. Examining water management in these two villages, we asked what choices women had and why they made decisions that continued to expose them to the risk for schistosomiasis. They found that advice to “Keep away from the canal!” was not relevant to their situation. A number of factors influenced women’s water management choices, and hence, their use of the canal: effort involved, water quality and cost, and an appreciation of the opportunity for social interaction with relatives and neighbors.

Water disinfection for international and wilderness travelers.

Acquisition of waterborne disease is a substantial risk for international travelers to countries with inadequate sanitation facilities. It also poses smaller but still significant risks for wilderness travelers who rely on surface water in developed countries with low rates of diarrheal illness, such as the United States. This article reviews the etiology and risks associated with waterborne disease that might be encountered by both types of travelers. It also summarizes--and makes recommendations for--the various water-treatment methods available to travelers for reducing their risk of contracting waterborne disease.

School and anaemia prevention: current reality and opportunities--a Tanzanian case study

Iron deficiency anaemia is highly endemic in rural areas of Tanzania and in many developing countries. Its prevention among school children requires greater dissemination of knowledge of anaemia among children, teachers, parents and the general community. Associated improvements in the hygienic status of domestic and school environments are also often required. One-hundred-and-thirty-one anaemic children, 90 parents and 76 teachers were interviewed to ascertain their understanding of anaemia. Most children and parents had little knowledge of the symptoms, causes and prevention of anaemia. In addition to their iron-deficient diets, more than half of the children went to school without something to eat at breakfast and during school hours. However, parents and teachers were willing to work together to provide meals for the children. Poor sanitation in the children's homes and in schools was a little recognized factor which could pose a serious risk of anaemia. In addition, inadequate sanitation facilities and poor quality of physical environment prevailed both in the children's homes and in schools. The findings suggest the need for the establishment of a health-promoting schools network to provide a comprehensive framework for health promotion in schools as well as in homes in Tanzania and in other developing countries. Schools can be an ideal setting to positively influence a community's health status. Partnerships among teachers, parents and the wider community are required to identify, prioritize and ameliorate health problems.