Pit Latrines Research Articles

Isotope Hydrology and Hydrogeochemical Signatures in the Lake Malawi Basin: A Multi-Tracer Approach for Groundwater Resource Conceptualisation

Reliance on groundwater is outpacing natural replenishment, a growing imbalance that requires detailed and multi-faceted water resource understanding. This study integrated water-stable isotopes and hydrogeochemical species to examine hydrogeochemical processes during groundwater recharge and evolution in the Lake Malawi basin aquifer systems. The findings provide insights into groundwater source provenance, with non-evaporated modern precipitation dominating recharge inputs. Grouped hydrochemical facies exhibit five groundwater water types, prominently featuring Ca-Mg-HCO3. Modelled hydrogeochemical data underscore dominant silicate dissolution reactions with the likely precipitation of calcite and/or high-Mg dolomitic carbonate constrained by ion exchange. Isotope hydrology reinforces water resource system conceptualisation. Coupled isotopic-hydrogeochemical lines of evidence reveal a discernible spatial-seasonal inhomogeneity in groundwater chemical character, revealing a complex interplay of meteoric water input, evaporative effects, recharge processes, and mixing dynamics. Findings show that measurable nitrate across Malawi highlights a widespread human impact on groundwater quality and an urgent need for detailed modelling to predict future trends of nitrate in groundwater with respect to extensive fertiliser use and an ever-increasing number of pit latrines and septic systems arising from rapid population growth. This study not only refined the Lake Malawi basin aquifer systems conceptualisation but also provided isotopic evidence of groundwater and lake water mixing. This study sets a base for groundwater management and policy decisions in support of the Integrated Water Resources Management principles and Sustainable Development Goal 6 objectives for groundwater sustainability in the transboundary Lake Malawi basin.

Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi

BackgroundMenstrual hygiene management (MHM) is associated with the menstrual process in women and adolescent girls who face cultural and financial challenges in rural areas of many developing countries. As part of the pilot study, we assessed the sustainability and effectiveness of the approaches and lessons learned from the MHM project intervention in rural areas of Lilongwe, Malawi.MethodsRural primary schools (n = 4) were purposively selected where an MHM intervention was implemented in Lilongwe, Malawi. The study employed a mixed-method research design. Assessments and data collection were performed through surveys of learners, literature reviews, key informant interviews (KIIs) (n = 90), and 20 focus group discussions (FGDs). The study participants included boys and adolescent girls (n = 100, 11–19 years; grades 5–8), teachers, mother groups, and community leaders from the selected schools.ResultsAll the schools had water sanitation and hygiene facilities and latrines (45% improved, 54% ventilated improved pit latrines – VIPs) that promoted menstrual hygiene for adolescent girls. However, two of the schools studied (50%, n = 4) did not have separate washrooms for changing sanitary materials. There was a slight increase in latrine coverage in Kabuthu zone communities (90% at baseline versus 93.4% at midterm). However, the coverage dropped to 85.7% at the final evaluation, which was attributed to too much rain received in the area that damaged most of the latrines. There was a significant reduction (p < 0.05) in the number of girls failing to attend classes due to menstruation (70% at baseline versus 14% at final evaluation). Furthermore, the project resulted in the majority of girls (94.4%) having access to school. There was a strong uptake and adoption of sanitary products (reusable pads and menstrual cups) among adolescent girls of all age groups. The study has demonstrated that the inclusion of key stakeholders such as health workers, parents, mother groups and community leaders promoted the uptake and sustainability of reusable pads and menstrual cups and MHM interventions and programs.ConclusionThe MHM project implementation improved adolescent girls’ education in the area. The inclusion of boys and other key stakeholders in the health education talks addressed issues of stigma and discrimination. The study, therefore, calls for comprehensive training on MHM and hygiene education to remove discrimination and harmful cultural practices.

Examining the Impact of Environment on Pupils’ Academic Performance at PLE in Kitagata Town Council of Sheema District, Uganda

The study was conducted from three selected primary schools in Kitagata Town Council of Sheema District, Uganda. Case study research was used for this study, data were collected using open-ended and closed-ended questionnaires. Findings show that most primary schools in Kitagata Town Council, Sheema District lacked a conducive learning environment. the study calls for head teachers, teachers, parents, government and other stakeholders to give special attention to the condition of sanitary facilities in schools and the provision or improvement of existing utilities such as water, pit latrines and electricity. More so, parents, teachers, head teachers and the government should always ensure that pupils are provide with enough instructional materials so as to facilitate effective learning. Furthermore, Ministry of Education and Sports should invest in rehabilitating and renovating the existing buildings in primary schools where the already exist. Additionally, Parents Teachers Association in various primary schools should encourage parents to support and become more involved or take more responsibility for maintenance of existing structures in their schools. Keywords: Academic performance, Environment, Government, Instructional materials, Learning facilities

Second trimester vaginal Candida colonization among pregnant women attending antenatal care in Bukavu, Democratic Republic of the Congo: prevalence, clinical correlates, risk factors and pregnancy outcomes

IntroductionVaginal Candida colonization (CC) can lead to vulvovaginal candidiasis, the second most prevalent vaginal condition worldwide, and has been associated with adverse birth outcomes. However, no data on CC in the Democratic Republic of the Congo are available. We investigated the prevalence, Candida species, clinical correlates, risk factors and pregnancy outcomes in women with CC in the second trimester of pregnancy.Material and methodsIn Bukavu, the Democratic Republic of the Congo, pregnant women were recruited during antenatal care between 16 and 20 weeks of gestation from January 2017 to October 2017 and followed until delivery. Sociodemographics, sexual behavioral, hygienic and clinical characteristics, microbiological data and pregnancy outcomes were collected. Candida detection and speciation was performed with microscopy (Gram-stained smears and wet-mount) and/or quantitative PCR. Multivariate regression models were used to estimate the different associations with CC.ResultsThe prevalence of CC by wet mount, microscopy of Gram-stain smears and qPCR was 27.9%, 28.1% and 38.2%, respectively. C. albicans was the most prevalent Candida species (91.0%). Previous genital infections, an intermediate vaginal microbiota, bacterial vaginosis, and the use of pit toilets were risk factors for CC. Clinically, CC was associated with itching only. Women with CC had twice the odds for preterm birth, if Candida concentration was high, the odds were four times higher.ConclusionsIn Bukavu, the Democratic Republic of the Congo, the prevalence of CC was high and associated with microbiological and modifiable risk factors. Screening and treatment for CC during antenatal care should be investigated as a possible strategy to reduce preterm birth.

Prevalence and Risk Factors of Human Taenia solium Cysticercosis in Mbulu District, Northern Tanzania

Background: Taeniosis and cysticercosis are human infections caused by the pork tapeworm, Taenia solium. This study is a baseline for community-based intervention. We determined the prevalence of human cysticercosis and associated risk factors following a deworming program conducted throughout the country, with Mbulu District being among the districts in Northern Tanzania. Methods: Human cysticercosis was determined by enzyme-linked immunosorbent assay (Ag- ELISA). Household interviews and observations were conducted to identify risk factors for cysticercosis transmissions among households and communities. Results: Three hundred individuals participated in this study. The age ranged from 5 to 89 years, with a median of 19 years. The prevalence of human cysticercosis was 23 (7.67%). The prevalence was high with 6 (11.76%) among individuals aged 26 to 35 years and ±45 years. There was no statistically significant difference in the prevalence by age group, sex, or occupation. Among the 300 participants, 82 (27.3%) had received anthelmintics during the previous year; among these, 5 (21.7%) were infected. The likelihood of infection was low among anthelmintic users by 28% [0.72 (0.26–2.01)], but the protection was not significant. The communities differed in risk factors on the availability of a clean and safe water supply; 52.7% (46/86) of households visited had no pit latrine. The cysticercosis prevalence showed a significant difference in communities. Conclusions: The prevalence of human cysticercosis was high and associated with higher age groups. The prevalence was low among those who had taken anthelmintics and was associated with lower age groups. The current school deworming program has a positive effect on school children, while the elderly are at higher risk because the intervention did not target them. It is recommended to scale up anthelmintic intervention to higher age groups.

Water, sanitation, and hygiene factors associated with nutrition status among children under five years in Ewaso Narok Wetland, Laikipia County, Kenya

Background: Wetlands are known to harbor disease-causing bacteria, posing health risks that can be mitigated through improved water, sanitation, and hygiene (WASH) practices. This study aimed to understand the factors affecting nutritional status and its connection to WASH-related diseases among children under five in Ewaso Narok Wetland, Laikipia County. Methods: Using a mixed-method approach, qualitative and quantitative data were collected. Simple random method was used to identify the respondents. Results: Findings revealed that 36% of households surveyed had children with nutritional edema, with mean age, weight, and height at 21 months, 11 kilograms, and 73 centimeters respectively. Using WHO standards, a significant proportion of children were found to be undernourished at 45.3% and stunted at 41.3%. Socio-demographic factors like caregiver education level and marital status were identified as influential on the nutrition status. While 51% of households had unimproved water sources, 86% had access to toilet facilities, predominantly traditional pit latrines. 67% of the respondents were located near a wetland with a proximity ranging from 1km to 5km. Disease prevalence among children included diarrhea (46%), typhoid-related fevers (22%), and malaria (12%), with edema significantly associated with WASH diseases. Conclusions: Factors such as feces disposal, wetland proximity, protective gear use, handwashing, and toilet facilities were linked to child nutrition. Recommendations include implementing WASH programs, improving water and sanitation access, promoting hygiene practices, ensuring safe feces disposal, using protective gear in wetlands, and advocating for improved toilet facilities. Further research is warranted to assess intervention effectiveness and explore additional influencing factors.

Typhoid fever in children in Goroka, Papua New Guinea.

Typhoid is endemic in many low-income countries, including in Papua New Guinea. This study aimed to describe the burden and clinical features of typhoid in children in a provincial hospital, to describe environmental conditions that lead to typhoid, and to document the antibiotic sensitivity of Salmonella spp. in the Eastern Highlands Province. A combined retrospective and prospective study of children admitted to with clinical features of typhoid to the Goroka Hospital throughout 2022. The study included 98 children, of which 54% were female. The median age was 8 (IQR 5-10.6) years. Over 60% of the patients were from Goroka District, the peri-urban area encompassing the town and surrounds. Ninety-four percent (92) of the patients used a pit latrine as a toilet and only 28% had access to treated water. Neuropsychiatric symptoms were common (60%), as was leukopenia (48%), thrombocytopenia (52%) and anaemia (42%). Thirty-seven patients had positive blood cultures for Salmonella typhi; all isolates were sensitive to third-generation cephalosporins, pefloxacin, ampicillin, trimethoprim and sulfamethoxazole, and only 54% sensitive to chloramphenicol. The median duration of hospitalisation was 6 days (IQR). There were no deaths. Prompt public health actions are needed to reduce the burden of typhoid infection in the Papua New Guinea. The conjugate typhoid vaccine should be considered in the highlands region, where typhoid is most endemic.

Wastewater-based epidemiology as a public health resource in low- and middle-income settings

In the face of emerging and re-emerging diseases, novel and innovative approaches to population scale surveillance are necessary for the early detection and quantification of pathogens. The last decade has seen the rapid development of wastewater and environmental surveillance (WES) to address public health challenges, which has led to establishment of wastewater-based epidemiology (WBE) approaches being deployed to monitor a range of health hazards. WBE exploits the fact that excretions and secretions from urine, and from the gut are discharged in wastewater, particularly sewage, such that sampling sewage systems provides an early warning system for disease outbreaks by providing an early indication of pathogen circulation. While WBE has been mainly used in locations with networked wastewater systems, here we consider its value for less connected populations typical of lower-income settings, and in assess the opportunity afforded by pit latrines to sample communities and localities. We propose that where populations struggle to access health and diagnostic facilities, and despite several additional challenges, sampling unconnected wastewater systems remains an important means to monitor the health of large populations in a relatively cost-effective manner.

Utilization of Environmental Sanitation Policy Guidelines on the Use of Sanitation Facilities in Public Primary Schools

There is a need for a healthy and conducive learning environment, safe drinking water, and child-friendly sanitation facilities in the school where children spend a lot of time. The objectives of the study were to establish the use of existing types of sanitation facilities and find out the status of the existing types of sanitation facilities within primary schools concerning Kenya School Health Policy and the Safety Standards Manual for schools. To achieve its objective, the study adopted a descriptive survey design. A sample of 169 schools was selected from the 773 primary schools in Meru County using simple random sampling. Data was collected using a structured direct observation schedule. Data was analyzed using SPSS software. Descriptive statistics including mean and cross-tabulations were used. The study purposively sampled 167 primary school heads with boys and girls populations of 132,180 and 131,712 respectively. Pearson’s Chi-Square test was used to determine relationships between the variables. The study revealed that 75% of the schools visited kept hygiene and had pit latrines with hand washing stations. Through observation, it was evident that 93% of the schools visited had clean environments that were free from litter. The study concluded that ratios for the sample population fell within the WHO guidelines which recommend a ratio of 25:1 for girls and 50:1 for boys’ toilets. It was concluded that in 46.1 % of the sampled primary schools, pupils living with disabilities experienced challenges in accessing sanitation facilities. The study recommended schools come up with clear budget provisions on sanitation that includes employing a staff specifically for cleaning toilets

Influence of economic factors on feacal emptying, conveyance and disposal:

Safe management of faecal waste is one of the Sustainable Development Goals (SDGs) which envisions safe sanitation for all. However, although efforts to improve sanitation conditions in slums have been made, faecal emptying, conveyance and disposal still remain a challenge endangering the health of the public. The study examined the influence of economic factors on faecal emptying, conveyance and disposal in on-site sanitation facilities in Meru slums. A convergent design with a mixed methods approach was adopted. Quantitative data was collected using structured questionnaires from a sample of 228 household heads selected using cluster and proportionate simple random sampling techniques. Correlation and regression analysis was carried out to ascertain the association between emptying, conveyance and disposal of faecal waste and the economic factors. Qualitative data was gathered using focus group discussion participants with eight (8) who included four (4) pit operators, 3 household heads and 1 Public Health Officer (PHO) and results analyzed thematically. Findings showed that only 31% of slum dwellers emptied latrine pits and that manual emptying was more common (84%) than mechanical emptying because of its cost efficiency, reliability and the effectiveness in handling plastics, glasses, metal pieces, diapers and sanitary pads contained in pits. Increased cost constrained faecal emptying, conveyance, and disposal (r=0.499, p-value=0.000). Residents who were able to pay for faecal handling services were more likely to practice hygienic faecal emptying, conveyance, and disposal (r=0.524, p-value=0.000). Low level of income for majority of slum dwellers influenced the design of the latrines adopted. Emptying faeces from poorly designed pit latrines was more expensive due to operators’ safety concerns. The study concluded that the inability to meet the costs associated with faecal emptying, conveyance and disposal services facilitated poor sanitation status in slums. There is need to sensitize the slum community on the benefits of practicing safe management of faecal waste. The study recommended development of government policies to regulate mechanical emptying conveyance and disposal of faecal matter.

Developing an Infrastructure Intervention for Solid Waste Exclusion in Pit Latrine Faecal Sludge

Pit latrine emptying is an important maintenance practice meant to increase a toilet's lifespan. However, the presence of solid waste in faecal sludge pose a great challenge during pit emptying, faecal sludge treatment and processing. Recent studies have demonstrated that solid wastes cause pits to fill up at a faster rate, destruct faecal sludge decomposition, and cause damage to emptying devices by blocking machine parts, and in some cases breaking them. When such occurs, emptying devices are usually withdrawn to manually remove the trapped debris, causing a loss of valuable time and reductions in daily revenue. One way of averting the adverse effects of solid wastes in pit latrines is by preventing them from mixing with faecal sludge in the pit. Therefore, the study aimed to design, develop and test an infrastructure intervention that would exclude solid waste from pit latrine faecal sludge. The study used a quantitative approach in which experimental methods were used to collect primary data. The methodology included the design, fabrication, and installation of a solid waste screening unit on a pit latrine. The screening unit was positioned directly below the squat hole to intercept solid waste while allowing excreta to pass through it. The unit was tested on a pit latrine that was used by 20 individuals over a period of 120 days, after which mass measurements of the intercepted solid wastes were done. The data obtained was analysed using Microsoft Excel 2016 version. It was found that the screening unit was capable of intercepting 88.2±0.6 % of the solid waste that entered the toilet through the squat hole. This confirmed that although behavioral, and education interventions have been conducted, there was little change in behavior towards the dumping of solid wastes in pit latrines. The study also showed that installing solid waste screening systems in future pit latrines can be one way of preventing solid wastes from mixing with pit latrine faecal sludge. These findings suggest that incorporating solid waste screening systems into future pit latrines could effectively prevent solid waste from mixing with faecal sludge. This intervention promises to complement existing behavioral and educational interventions prevalent in many developing countries. The study's application and findings promise improvements in faecal sludge management during pit emptying, treatment, and processing, thereby enhancing public health outcomes.

Pilot project demonstrating the feasibility of HIV antiretroviral therapy waste bottle collection and recycling

Background HIV remains a leading cause of morbidity and mortality in Uganda. At current levels of antiretroviral therapy (ART) coverage, ART waste bottles are becoming a challenge to both patients and the environment in Uganda. Additionally, ART improperly disposed of in the environment can end up in the food chain and lead to antimicrobial resistance. We aimed to pilot a feasibility study of collecting and recycling the used ART pill bottles at a large urban HIV clinic in Kampala, Uganda. Methods Patients were first engaged randomly during their clinic visits and asked how they disposed of the waste medication bottles. Verbal information on proper disposal options of these medication containers was provided to patients. Patients and caretakers were then encouraged to return the waste medication bottles to the clinic at the time of their next appointment. Posters conveying information about bottle returns were displayed and information leaflets were distributed. Finally, recycling partners were engaged to explore options for the bottles. Results From the group oral engagements performed, patients reported that a means to discreetly dispose of pill bottles was welcome due to the stigma associated with these bottles in the community. They reported previously throwing these bottles in pit latrines, informal rubbish pits, nearby bushes and burning them, all methods that endanger the environment. The process of returning bottles was widely adopted. 53kg of returned bottles were recycled to make each bench that are used by patients in the clinic. Conclusions This pilot study showed a high willingness among people living with HIV to return their used pill bottles. Collecting, storing and recycling was feasible and successful at one large urban HIV clinic in Kampala, Uganda. We, therefore, recommend expanding this model to more HIV clinics country-wide to reduce the environmental impact of HIV programmes.

Physical and Environmental Factors Influencing Accessibility to Sanitation and Hygiene Services Among People Living with Disabilities in Kitui County, Kenya

This study aimed to find out the physical and environmental factors influencing accessibility to sanitation and hygiene services among PLWD in Kitui County, Kenya. The study employed a cross sectional survey method. Disability status varied, with 44.2% having physical/mobility disabilities, 34.4% with visual disabilities, and 21.4% with hearing disabilities. In terms of physical and environmental factors, 95.6% had access to latrines, Improved pit latrines were the most common (52.3%). 93.3% reported sufficient space inside latrines, challenges included slippery floors (28.2%) and limited privacy (23%). Inferential statistics, employing logistic regression, identified significant associations. The logistic regression analysis elucidated significant factors influencing hygiene and sanitation accessibility among people with disabilities in Kitui County, Kenya. Socio-economic variables, including occupation (B = -0.212, p = 0.032), income (B = -1.068, p = 0.184), and education level (B = 0.457, p &lt; 0.001), exhibited notable associations. Physical and environmental factors, such as latrine design for people with disabilities (B = -0.566, p = 0.077), played a crucial role. This study identified substantial challenges hindering people with disabilities (PLWD) from accessing adequate sanitation and hygiene, revealing critical issues related to physical and environmental barriers.

Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study

BackgroundMultidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have strongly linked malnutrition to poverty. Some international studies point to the worse nutritional status of urban slum children than rural children. Limited data is available regarding the nutritional status of slum children in Karachi. This study aimed to determine characteristics of malnourished children in an urban squatter settlement in Karachi, Pakistan.MethodsA case- control study was carried out at the primary healthcare center of a squatter settlement in Karachi, Pakistan. All children under five years of age visiting the primary healthcare center were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. The controls were similar in terms of age group but had z scores between − 2SD and + 2SD. A self- structured risk factor questionnaire that included information about sociodemographic, economic and environmental factors as well as child- related characteristics was researcher administered via face-to-face interviews with the mothers of children. Univariate and multivariate logistic regression analyses were conducted. Crude and adjusted odds ratios were calculated with 95% confidence interval.ResultsA total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion of the sample originated from individuals with low household income. After adjusting for the confounders, childhood malnutrition was significantly associated with a low education level of father (aOR 4.86, 95% CI 2.23–10.60), a monthly income less than 25,000 PKR (89 USD) per month (aOR 7.13, 95% CI 1.67–30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67–7.3), less than six months of exclusive breast feeding (aOR 3.578, CI 1.58–8.08), inappropriate weaning age (aOR 3.71, 95% CI 1.53-9).ConclusionMalnutrition in children under five years of age in the community is associated with low family income, low paternal education, poor toilet facilities, lack of exclusive breastfeeding and inappropriate weaning age. The implementation of poverty reduction programs, sanitation provision at affordable rates, community-based breast feeding and weaning education intervention are urgently required to efficiently improve children’s nutritional status.

Tracking enteric pathogen contamination from on-site sanitation facilities to groundwater in selected rural areas of Vhembe District Municipality, Limpopo Province, South Africa

Groundwater is valued as a source of potable water, although it is vulnerable to environmental pollution. The aim of this study was to track enteric pathogen contamination from on-site sanitation (OSS) facilities to 70 household boreholes used by four villages of the Vhembe District Municipality. Two objectives were pursued: to measure the lateral distance between the borehole and the sanitation facilities in household yards, and to track the enteric pathogens. The borehole abstraction point and OSS system distance were determined using a steel measuring tape. Real-time PCR was used to track Shigella flexneri, Salmonella typhimurium, Campylobacter jejuni, and enterotoxigenic Escherichia coli (ETEC) from Wastewater (WW) from domestic septic tank and sludge from pit latrines to boreholes. Escherichia coli was used as an indicator of faecal contamination. Results showed that 25% of households kept a distance of ≥50 m between the OSS facilities and the boreholes. In total, 87.5% of household boreholes in the rainy season and 72.5% in the dry season were contaminated with E. coli and pathogenic bacteria: Shigella flexneri, Salmonella typhimurium, and ETEC. The concentrations of the pathogens ranged from 2.03 to 2.12 LogEGC/100 mL. A very weak (r = −0.093) to moderate (r = −0.541) association was found between pathogens in groundwater and on-site sanitation systems (WW from septic tank and sludge from pit latrine). This suggests that the pathogens were not present in the sanitation compartment when they were found in the groundwater and vice versa. Moreover, a very weak (r = 0.007) to moderate (r = 0.525) association was found between the detected contaminants in groundwater and the lateral distance between the OSS facilities and the boreholes. The pathogens detected in all samples showed consistent concentrations, suggesting potential contamination from OSS systems' waste, possibly in groundwater, indicating potential contamination. The siting of OSS facilities at the yards in this study appeared to have a slight influence on the contaminants detected in groundwater. This study calls for an education program to be implemented by the Water and Sanitation Services Authorities to prevent contamination of groundwater and the risk of waterborne diseases.

Production of low emission briquettes from carbonized faecal sludge as an alternative source of cooking energy

BackgroundIn Tanzania, firewood, charcoal, and agricultural waste play a crucial role in daily life as sources of cooking energy, especially in rural areas. Using these energy sources contributes to deforestation and the emission of harmful substances, leading to health problems. This study highlights the potential of faecal sludge briquettes as an innovative, environmentally friendly, and sustainable alternative to traditional energy sources to meet the increasing demand for cooking energy in Tanzania. The process involved sludge characterization, drying, sorting, carbonization, milling, briquette making, and characterization.ResultsA study was conducted to assess the presence of zinc (Zn), cadmium (Cd), and lead (Pb) in faecal sludge collected from households. The results indicates that the levels of these metals were all within the acceptable limits set by the Tanzanian Standards (TZS) for sludge disposal and use in the environment, which are 5.00 mg/L, 5.00 mg/L, and 30.00 mg/L, respectively. Septic tanks and pit latrines sludge had a concentration of 0.5 mg/L and 0.5 mg/L for Zn, 0.55 mg/L, and 0.6 mg/L for Cd, and 10.01 mg/L and 4.87 mg/L for Pb, respectively. Adding 75% charcoal dust improved the gross and net heating values from 10.47 and 10.16 to 19.29 and 18.86 MJ/kg, respectively. Similarly, adding 50% charcoal dust improved the gross and net heating values to 19.24 and 18.78 MJ/kg. The emission of particulate matter (micrograms/m3) was reduced from 30.4 and 35 to 10.3 and 11.8 for PM2.5 and 7 and 8 for PM10, while carbon monoxide emission decreased from 51.2 to 19.7 ppm.ConclusionThe results strongly suggest that briquettes made of carbonized faecal sludge mixed with other biomass materials could offer an alternative to traditional solid fuels, with the added benefits of reducing greenhouse gas emissions, deforestation, and longer burning times.

Mitigating Contaminant-Driven Risks for the Safe Expansion of the Agricultural-Sanitation Circular Economy in an Urbanizing World.

The widespread adoption of an agricultural circular economy requires the recovery of resources such as water, organic matter, and nutrients from livestock manure and sanitation. While this approach offers many benefits, we argue this is not without potential risks to human and environmental health that largely stem from the presence of contaminants in the recycled resources (e.g., pharmaceuticals, pathogens). We discuss context specific challenges and solutions across the three themes: (1) contaminant monitoring; (2) collection transport and treatment; and (3) regulation and policy. We advocate for the redesign of sanitary and agricultural management practices to enable safe resource reuse in a proportionate and effective way. In populous urban regions with access to sanitation provision, processes can be optimized using emergent technologies to maximize removal of contaminant from excreta prior to reuse. Comparatively, in regions with limited existing capacity for conveyance of excreta to centralized treatment facilities, we suggest efforts should focus on creation of collection facilities (e.g., pit latrines) and decentralized treatment options such as composting systems. Overall, circular economy approaches to sanitation and resource management offer a potential solution to a pressing challenge; however, to ensure this is done in a safe manner, contaminant risks must be mitigated.

Excreta flow mapping along the sanitation service chain, a case of Kombolcha town, Ethiopia

Poor management of fecal sludge (FSM) presents significant risks to public health and the environment. This study employed qualitative and quantitative data collection methods, along with the Shit Flow Diagram (SFD) data analyzing tool to investigate FSM patterns in Kombolcha town, Ethiopia. The findings indicate that 75.7% of housing unites in the town are shared toilets, with multiple households sharing a single facility. The primary toilet technologies used include cistern flush toilets (2.1%), pour/manual flush toilets (19.8%), ventilated improved pit latrines (11.1%), pit latrines with slabs (56.4%), and pit latrines without slabs (10.6%). However, 98.5% of these toilet types had either unlined or only partially lined containments. Furthermore, only 37% of households practice safe pit or sludge tank emptying. As a result, only 17% of fecal sludge goes through the sanitation value chain and is effectively treated, while 39% remains onsite and unemptied, and the remaining 44% is disposed of in a manner that poses risks to the environment and public health. The study highlights the significant public health and environmental risks associated with the high reliance on shared toilets, the prevalence of inadequately lined toilet types, and the low adoption of proper fecal sludge management practices. Addressing these challenges requires the implementation of sanitation bylaws and building code regulations that prioritize hygienic standards and promote improved toilet technologies.

Prevalence and Correlates of Stunting among a High-Risk Population of Kenyan Children Recently Hospitalized for Acute Illnesses.

Stunting (length/height-for-age z-score <-2) is associated with significant morbidity and mortality among children under 5 years of age in sub-Saharan Africa. Children who are stunted and recently hospitalized for acute illness may be at particularly elevated risk for post-discharge mortality. In this cross-sectional analysis, we measured the prevalence of stunting at hospital discharge and identified host, caregiver, and environmental correlates of stunting among children aged 1-59 months in Western Kenya enrolled in the Toto Bora Trial. Child age- and site-adjusted prevalence ratios were estimated using Poisson regression. Of the 1,394 children included in this analysis, 23% were stunted at hospital discharge. Older children (12-23 months and 24-59 months versus 0-5 months) had a higher prevalence of stunting (adjusted prevalence ratio [aPR]: 1.58; 95% CI: 1.04-2.36 and aPR: 1.59; 95% CI: 1.08-2.34, respectively). HIV-exposed, uninfected children (aPR: 1.94; 95% CI: 1.39-2.70), children with HIV infection (aPR: 2.73; 95% CI: 1.45-5.15), and those who were never exclusively breastfed in early life (aPR 2.51; 95% CI: 1.35-4.67) were more likely to be stunted. Caregiver education (primary school or less) and unimproved sanitation (pit latrine without slab floor or open defecation) were associated with increased risk of stunting (aPR: 1.94; 95% CI: 1.54-2.44; aPR: 1.99; 95% CI: 1.20-3.31; aPR: 3.57; 95% CI: 1.77-7.21, respectively). Hospital discharge represents an important opportunity for both identifying and delivering targeted interventions for nutrition-associated poor outcomes among a high-risk population of children.

The Komape litigation - ensuring effective remedies

The three Komape cases were spurred by the death of Michael Komape in 2014, when he drowned in a dilapidated pit toilet at his school in Limpopo. In the first judgment, the High Court recognised that the government had violated a host of rights - including the right to basic education and the rights of the children to have their best interests considered as paramount in any matter concerning them. However, the court refused to grant common law damages. This refusal was successfully appealed in the Supreme Court of Appeal. In the first judgment, the High Court also granted a structural order requiring the government to eradicate all pit toilets in the province. The plaintiffs did not appeal this part of the order. Subsequently, the plaintiffs needed to return to court after the government did not adequately comply with the structural order. The High Court once again ruled that the government was violating the rights of children by not urgently eradicating pit toilets in schools. A more detailed structural order was granted, requiring the government to formulate a new plan on urgent timelines. However, the court refused to extend its supervisory role. This article argues that structural orders have proved to be valuable tools in litigation for the right to basic education in the Komape case in particular. Further, the article argues that the High Court may have not fully understood the role of court-appointed agents in not granting a task team to monitor the government, as requested by the plaintiffs. The granting of a task team would have been appropriate in the case - given the gravity of the sanitation crisis, learners' right to basic education, and children's right to have their best interests be considered paramount in all matters concerning them.