Public Latrine Research Articles

Pathways of exposure to Vibrio Cholerae in an urban informal settlement in Nairobi, Kenya.

Cholera is a diarrhoeal disease caused by Vibrio cholerae (V. cholerae) bacterium, with strains belonging to serogroups 01 and 0139 causing a huge proportion of the disease. V. cholerae can contaminate drinking water sources and food through poor sanitation and hygiene. This study aimed to identify environmental routes of exposure to V. cholerae within Mukuru informal settlement in Nairobi. We collected nine types of environmental samples (drinking water, flood water, open drains, surface water, shaved ice, raw produce, street food, soil, and public latrine swabs) over 12 months. All samples were analysed for V. cholerae by culture and qPCR, then qPCR-positive samples were quantified using a V. cholerae DNA standard. Data about the frequency of contact with the environment was collected using behavioural surveys. Of the 803 samples collected, 28.5% were positive for V. cholerae by qPCR. However, none were positive for V. cholerae by culture. V. cholerae genes were detected in majority of the environmental water samples (79.3%), including open drains, flood water, and surface water, but were only detected in small proportions of other sample types. Vibrio-positive environmental water samples had higher mean V. cholerae concentrations [2490-3469 genome copies (gc) per millilitre (mL)] compared to drinking water samples (25.6 gc/mL). Combined with the behavioural data, exposure assessment showed that contact with surface water had the highest contribution to the total V. cholerae exposure among children while ingestion of municipal drinking water and street food and contact with surface water made substantial contributions to the total V. cholerae exposure for adults. Detection of V. cholerae in street food and drinking water indicates possible risk of exposure to toxigenic V. cholerae in this community. Exposure to V. cholerae through multiple pathways highlights the need to improve water and sanitation infrastructure, strengthen food hygiene practices, and roll out cholera vaccination.

Assessment of the Problems Associated with the use of Public Latrine System in Ife-North Local Government, Osun State, Nigeria

Public toilets are an essential means of sanitation in some developed countries and have been the only possible alternative for many people living in low-income, heavily populated, and informal settlements. The aim of this study was to assess the problems associated with the use of public latrine system in Ife-north local government, Osun State. The data used for the study were obtained through well-structured questionnaires. A total of 181 questionnaires were distributed and 150 questionnaires were retrieved, while 31 questionnaires were missing. The respondents were selected randomly for the study. The descriptive statistics showed that male respondents were the major participants in this study. 80% of the respondents in the study area had access to public toilet. The respondents identified Sit latrine as the major type of latrine system available in the area. This study revealed that majority (40.66%) of the households used the latrine every day and the latrine was being maintained properly by the community. The result of this study showed that 86.66% of the respondents were reported to have contacted diseases as a result of public latrine use. This study has shown that poor maintenance of practice exposed the users of latrine to various diseases. This study recommended that Community leaders must ensure that users have been sensitized on the correct use, appropriate maintenance, hand washing and other basic hygiene practices Keywords: Public toilets, sanitation, developed countries

Health among Slum Children- A Sociological Study of Chennai City

The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Child health is the purview of pediatrics, which became a medical specialty in the mid-nineteenth century. Before that time the care and treatment of childhood diseases were included within such areas as general medicine, obstetrics and midwifery. A slum is a densely populated urban area and characterized by low standard of living. The rapid urbanization and increase in population resulted in the depletion and degradation of natural resources. Industrial expansion lead to the increase in the job potential in large cities, which attracted the rural population to migrate to cities and further converted the cities into a major slum and concrete jungles. Numbers of slums are increased in metropolitan cities due to acute shortage space for housing. At the same time, access to services like healthcare, fresh food, and basic sanitation may start to become restricted, creating filth and squalor. The present study titled Health among Slum Children- A Sociological Study of Chennai city has focused on the health conditions of Slum Children with three research objectives as (i). To find out the socio-economic background of the slum children in Chennai city, (ii). To bring out the nature and causes of health problems among slum children and (iii) To identify the types of health problems among slum children. The present study is descriptive in nature and tries to find out the nature and causes of health problems of slum children. The universe of the research is the total number of households of Ayothikuppam slum (1250 HH) and Saidapet slum (2220 HH). The total numbers of households are 3470. In order to have reliable data collection, the researcher has interviewed 50 slum children from the age group of 8-14 on the basis of convenient sampling method under Non-Random Sampling. The researcher has used interview schedule to collect data from the respondents. The findings of the study divulges that most of the slum children experienced diseases or health problems once in a month which are cold, cough and fever. During the illness time, 26% of the slum children were going to government hospital. 60% of the slum children are not having the habit of washing their hands before taking meals due to them play with friends and neighborhoods. 40% of the slum children are frequently affected by the fever like Malaria, Typhoid and 20% of the slum children were affected by cold and cough; sometimes it was in severe stage. The study has provided the following recommendations; i). Government has to provide formal education to the slum children and to guide them to go to school, ii) Government should take necessary step to clean the slum areas and near the Kuvam River, iii) NGO’s has to conduct more number of medical camps, awareness programmes about health and education to the slum children as well as their parents and iv) The government has to construct the public latrine for the slum areas.

Healthy Latrines Prevent Diarrhea as an Effort to Reduce STOP Defecation in Kutalimbaru Village, Deli Serdang Regency

The case of diarrhea reached 18.39% in the village of Kutalimbaru where the people are still having open defecation in the river. Open defecation causes clean water resources contaminated by e’coli bacteria since people in Kutalimbaru still use rivers as a source of clean water. 17,1% of the head of the family have not yet had a latrine while the public latrine facility in this village is no longer functioning. The methods used to solve the problems were community approach, diagnosis of action, socialization, education and action to build a healthy latrine in Dusun III Kutalimbaru. The built latrine was a model latrine. The latrine meets 10 indicators of a healthy latrine and is equipped with environmentally friendly innovations, has a fiber roof and has a vertical garden using used bottles. Evaluation is still ongoing to improve and maintain the sustainability program.

Environmental enteropathy and its association with water sanitation and hygiene in slum areas of Jimma Town Ethiopia.

Environmental Enteropathy is an inflammatory condition of the gut that leads to intestinal barrier dysfunction. It is a common problem in resource-limited countries and results from exposure to larger quantities of fecal bacteria to poor personal hygiene and environmental sanitation. Due to poor intestinal permeability, there is a problem with absorption of nutrients, which in turn leads to growth faltering, poor cognitive development, and oral-vaccine failure. The aim of this study was to identify the children with an elevated lactulose to mannitol ratio (indicative of possible environmental enteropathy) and its association with water sanitation and hygiene in slum areas of Jimma Town so as to mitigate the problem of malnutrition in under-five children. A community-based cross-sectional study was carried out from January to April 2021. A Lactulose mannitol test was performed to determine the prevalence of elevated lactulose to mannitol ratio (possibly environmental enteropathy) in children aged 12 to 59 months. A pretested questionnaire was used to collect data on water sanitation and hygiene (WASH) indicators and sociodemographic characteristics. A multivariable logistic regression analysis was used to isolate independent predictors for possible environmental enteropathy. All tests were two-sided and statistical significance was declared at P<0.05. The results of this study showed that 19.3% (95%CI: 14.8-23.7) of children had an increased lactulose to mannitol ratio (>0.15). On multivariable logistic regression analysis, the variables drinking water from unimproved water sources (AOR 3.741; 95%CI: 0.914-15.310,p = 0.048), unsafe coverage of water storage (AOR 0.363; 95%CI: 0.169-0.777, P = 0.009), public latrine utilization (AOR 0.139 95%CI: 0.024-0.816, P = 0.029),and hand washing less than 3 critical time of hand washing practices (AOR 4.369;95%CI: 1.411-13.524,P = 0.011) were significantly associated with an increased in lactulose mannitol ratio (possible indicative of intestinal permeability/environmental enteropathy). This study showed that one fifth of under-five children in Jimma Town had an elevated lactulose to mannitol ratio (possibly environmental enteropathy). The WASH sectors and other governmental organizations should give emphasis to areas with poor water sanitation and hygiene to mitigate the problem of environmental enteropathy and related consequences like growth faltering, poor cognitive development, and oral-vaccine failure in the study area.

Impact of usership on bacterial contamination of public latrine surfaces in Kathmandu, Nepal

According to the United Nations (UN) Sustainable Development Goals (SDGs), community or public toilets shared by more than one household are not considered “safely managed” under SDG 6.2. However, many populations around the globe, particularly in urban settings, lack access to private sanitation facilities. For this reason, there is a need to evaluate the cleanliness of community or public toilets in these settings and examine best practices for maintaining them. This study had three aims: 1) build on previous data collected in March 2018 at public latrines to determine whether cleaning protocols were sustained, 2) examine relationships between latrine cleanliness and usership, and 3) identify latrine surfaces with higher concentrations of bacterial contamination. In March 2018 and December 2019, swab samples were collected from public latrine surfaces in Kathmandu, Nepal. Sampling occurred in “clean” conditions–after cleaning and before the latrine was opened for use–and “dirty” conditions–during operating hours. Samples were analyzed for concentrations of total coliforms (TC) and Escherichia coli (EC). The number of latrine users prior to the “dirty” sample collection was recorded (in December 2019 only). Results found that both TC and EC concentrations were significantly lower during “clean” rather than “dirty” conditions and both TC and EC concentrations increased with the number of users over time. TC and EC concentrations differed by surface type during dirty and clean conditions (p&lt;0.05). Findings suggest cleaning protocols established at this public toilet site were adequately maintained two years later.

A Cross-Sectional Study on Menstrual Health Practice and Needs Among Female Rohingya Residing in Malaysia: An Interim Analysis

Objectives: Not much is known about the menstrual practices and needs among Rohingya females residing in Malaysia. This knowledge gap needs to be addressed, in line with the efforts toward family planning. The objectives of the study are to describe menstrual practices among female Rohingya and to assess whether their menstrual needs are met during their last period. Methods: This is a cross-sectional study involving Rohingya females aged 18 to 55 years old attending QFFD Clinic run by IMARET in Selayang, Selangor between April to July 2022. Menstrual practices and needs were assessed using self-administered questionnaires; the Menstrual Practices Questionnaire (MPQ) and the Menstrual Practice Needs Scale (MPNS-36), respectively. Results: A total of 40 respondents have completed the questionnaire. Only 42.5% (n=17) of respondents have good experiences during their past menstrual cycle despite most of the respondents were able to meet their materials and home environment needs (n=27, 67.5%) and are less concerned when managing the disposal of their menstrual materials (n=25, 62.5%). Though, only 12.5% (n=5) of respondents have their transportation and school environment needs were met during their past menstrual cycle and 37.5% (n=15) of the respondents have concerns with the quality of their menstrual materials. The most common menstrual materials used by respondents at home and while away from home are disposable sanitary pads (n=35, 87.5% and n=36, 90.0% respectively). Many of the respondents prefer to dispose them inside the household rubbish bin which is inside the latrine when at home (n=36, 90.0 %) while the bin in the public latrine or toilet is used when disposing menstrual materials while away from home (n=32, 80.0%). Conclusion: Most of the female Rohingya refugees were able to practice safe and clean menstrual management. Though, some of their needs were not met, especially during transportation and away from home. It is important for non-government organizations like UNHCR to fight for their legal status in Malaysia so that they can feel safe and secure without it impacting their health negatively. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S17

Community interactions and sanitation use by the urban poor: Survey evidence from India’s slums

While the current scholarship on open defecation overwhelmingly focuses on increasing access to sanitation facilities as the solution, millions of people around the world still practise open defecation despite having latrines. This is especially problematic in urban slums where people are more vulnerable to sanitation-related diseases compared with rural areas because of their high population density. We explore why latrines are not being used even when they are available to slum dwellers by identifying social interactions that serve as information channels that promote public latrine use. Using an original survey in New Delhi, we find that slum dwellers who frequently interact with slum leaders, more so than other community leaders, are more likely to use nearby public latrines regularly. A survey of slum leaders finds that their role in fixing and maintaining public latrines and informing others of these acts as well as educating people on hygiene encourage public latrine use.

What motivates open defecation? A qualitative study from a rural setting in Nepal.

IntroductionOpen defecation is ongoing in Nepal despite the rise in efforts for increasing latrine coverage and its use. Understanding the reasons for open defecation would complement the ongoing efforts to achieve the ‘open defecation free’ status in Nepal. This study aimed at exploring different motivations of people who practice open defecation in a village in Nepal.MethodsThis study was conducted among the people from the Hattimudha village in Morang district of eastern Nepal, who practiced open defecation. Maximum variation sampling method was used to recruit participants for 20 in-depth interviews and 2 focus group discussions. We adopted a content analysis approach to analyze the data.ResultsWe categorized different reasons for open defecation as motivation by choice and motivation by compulsion. Open defecation by choice as is expressed as a medium for socializing, a habit and an enjoyable outdoor activity that complies with spiritual and religious norms. Open defecation by compulsion include reasons such as not having a latrine at home or having an alternative use for the latrine structures. Despite having a private latrine at home or access to a public latrine, people were compelled to practice open defecation due to constraints of norms restricting latrine use and hygiene issues in general. For women the issues with privacy and issues refraining women to use the same latrine as men compelled women to look for open defecation places.ConclusionOpen defecation is either a voluntary choice or a compulsion. This choice is closely linked with personal preferences, cultural and traditional norms with special concerns for privacy for women and girls in different communities. The ongoing campaigns to promote latrine construction and its use needs to carefully consider these factors in order to reduce the open defecation practices and increase the use of sanitary latrines.

Las termas legionarias de León. Análisis e interpretación arqueológica de su ángulo sureste

In 1996, the archaeological interventions in Puerta Obispo zone of the city of Leon, next to the east gate of the legionary fortress, revealed the remains of a Roman building dismantled almost at foundations level. The archeo-architectonic analysis has allowed us to known its complete constructive sequence. The building was directly connected to the great legionary baths that occupied a large block under the medieval cathedral. This space was occupied at first by the large pool of a baths frigidarium, inscribed in a large room. In a later constructive phase, the pool was amortized and reused, forming the infrastructure of quadrangular public latrine –forica–. This transformation must have taken place at the time the porta principalis sinistra was built at the end of the 1st century ad. The latrines remained in use until the middle of the third century ad, when this space undergoes a new adaptation.

Socio-cultural determinants of open defecation in rural households of Perambalur district, Tamil Nadu

Background: In many areas of the world, including India, open defecation still remains the predominant norm and poses one of the biggest threats to the health of the people particularly in rural areas.Objectives were to study the prevalence and socio-cultural determinants of open defecation in rural area of Perambalur district.Methods: The present cross-sectional was done in a three randomly selected villages falling under rural field practice area of Department of Community Medicine of Dhanalakshmi Srinivasan Medical College and Hospital in Perambalur district (Tamil Nadu). Data was collected on 330 houses using pre-tested interview schedule developed using SBM-G questionnaire/schedule for ODF verification for household surveys which was modified for present study. Statistical analysis was done using Epi Info version 7 software.Results: Most (89.1%) of the study participants were above 30 years of age. Majority of respondents (39.4%) were illiterate. Prevalence of open defecation was 78.8%. Only 70 (21.2%) houses were using household sanitary latrines. Various reasons reported for open defecation were unawareness about availability of public latrine (41.5%), inadequate water (15.3%), insufficient space for latrine construction (16.9%), inadequate money (10%), considering open defecation better (16.6%) and caste based discrimination (0.4%). The study found sex, education and occupation of head of family to be significantly associated with open defecation.Conclusions: This study highlights the need for implementation well planned behavior change communication strategy to stop the menace of open defecation.

Intestinal parasites from public and private latrines and the harbour canal in Roman Period Ephesus, Turkey (1st c. BCE to 6th c. CE)

To improve our knowledge of the parasite species affecting the inhabitants of Roman period Asia Minor, we analysed faecal material from Ephesus, Turkey. Mineralised material from the drain from a private house latrine (3rd c. CE), sediment samples from the sewer drain of a public communal latrine (6th c. CE), and sediment from the harbour canal (ca. 1st c. BCE to ca. 6th c. CE) were studied for the presence of intestinal parasites. Samples were viewed by light microscopy for helminth eggs, and commercial enzyme-linked immunosorbent assay (ELISA) kits were used to test for protozoal parasites that cause dysentery. Eggs of roundworm were found in the public latrine, whipworm in the house latrine, and both whipworm and roundworm in the harbour canal. Sequential sampling of the harbour core suggests that whipworm was by far the most common parasite throughout the Roman period, and there was no clear evidence for change in parasite species over the centuries. Whipworm and roundworm are both spread by the contamination of food and drink by human faeces. Despite the large number of travellers to Ephesus, as the capital of its province and a major port city in the Roman Empire, there was a surprising lack of diversity in parasite species found. This is especially apparent when we consider that ten species of intestinal parasite have been found across the Roman Empire. This is the first Roman site to be directly assessed for differences between infection in individuals using private latrines, public latrines, and mixed town effluent (in the harbour) at the same site.

Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana

.In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered “improved sanitation” because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one’s own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5–12 years and for disposal of feces of children < 5 years, compared with households using public latrines. However, within-compound access was not associated with improved child feces disposal by other caregivers in the compound. Feces was rarely observed in household compounds but was observed more often in compounds with latrines versus compounds relying on public latrines. Escherichia coli and human adenovirus were detected frequently on household surfaces, but concentrations did not differ when compared by latrine access or usage practices. The differences in latrine use for households sharing within-compound versus public latrines in Accra suggest that disaggregated shared sanitation categories may be useful in monitoring global progress in sanitation coverage. However, compound access did not completely ensure that households were protected from feces and microbial contamination.

Prevalence of intestinal parasites among street beggars in Jimma town, Southwest Ethiopia

ObjectiveTo determine the rate of intestinal parasitic infections and related risk factors among street beggars in Jimma town from February 10 to March 20, 2010. MethodsA cross sectional study was conducted on 116 street beggars cached at four different churches in Jimma town during ‘Abbey’ or two months Easter Christian fasting days. Interview was made using a structured questionnaire to collect socio-demographic data. Concentrated stool samples were collected and examined microscopically using direct wet smear. The data was analyzed using SPSS version 11.5 software package. ResultsOf 116 street beggars whose stool had investigated, 104 (89.7%) harbored one or more intestinal parasites. The most frequent intestinal parasites were Ascaris lumbricoides 76 (65.5%) followed by Trichuris trichiura 52 (44.8%). Schistosoma mansoni accounted 14 (12.1%) and hook worm 11 (9.5%). The rate of multiple parasitic infections was 63 (54.3%). The finger nail status, habit of shoe wearing and using source of river water for bathing showed statistical significant association with parasitic infections (P < 0.05). ConclusionsNinety percent of street beggars harbored intestinal parasites and yet they do not have accesses to latrine indicates, these people obviously contribute for the spreading of parasites to the community and being potential risk for the environmental contamination. Therefore, regular deworming activity and insuring accesses of adequate public latrine in selected sites of the Jimma town need help to control parasitic infections in this town.

Composting toilets a misnomer: Excessive ammonia from urine inhibits microbial activity yet is insufficient in sanitizing the end-product

End-product from 16 public mixed latrine style composting toilets (CTs) at 12 sites between 50 and 2100 m.a.s.l. in Western North America was tested in order to evaluate the effect of composting variables (TS%, NH3–N, temperature, and material age) on compost quality and hygiene (VS%, Escherichia coli, NO3−–N, and pH). Principal component analysis indicated that TS%, temperature, and material age equally contributed to reduction in VS%. NH3–N had the greatest effect on NO3−–N, E. coli, and pH. Nitrification was significantly inhibited above 386 mg/kg NH3–N, but no such limit was found for E. coli, despite a significant (p = 0.016) but weak (r2 = 0.11) negative relationship. It may be possible to amplify the sanitizing effect of ammonia and overcome pathogen resistance due to low temperatures and re-contamination (caused by poor design) with generous dosing of urea and ash. However, even sanitized, the fertilization effect of discharged material on the natural environment may not be desired or permitted in parks or protected areas where many CTs were found. To this end, operators of CTs need to evaluate their primary management objectives and ensure congruency with proven system capabilities.

Faecal biomarker and archaeobotanical analyses of sediments from a public latrine shed new light on ruralisation in Sagalassos, Turkey

A public latrine in the ‘Imperial Baths’ of Sagalassos was transformed into a dump site in the early Byzantine period. Several layers of urban waste, including ceramics, bones, glass and perhaps excrements were deposited on the floor. Faecal biomarker analyses and archaeobotanical analyses were conducted to reconstruct the history of the room. 5β-stanols of human origin, such as coprostanol, were found in the sewage channels together with mineralised plant remains, indicating a human faecal context. The botanical remains are furthermore representative of the Roman diet of the Sagalassians. Soil layers, deposited on top of the latrine floor and dating to the early Byzantine period, contained herbivore derived 5β-stanols, such as 5β-stigmastanol and epi-5β-stigmastanol. Additionally, a clear predominance of epi-5β-stanols over 5β-stanols showed that the animal dung has been subject to composting. In this period, the former latrine was clearly used as a manure production site which is further confirmed by stratigraphic evidence of large amounts of urban waste artefacts, which were commonly collected together with manure before application on the fields. The results of the present study support the theory that off-site potsherd scattering can be used as a proxy for manuring events. Additionally, the data show key evidence for vertical migration of 5β-stanols and presumably also for the leaching of bile acids.

Selection of sustainable sanitation technologies for urban slums — A case of Bwaise III in Kampala, Uganda

Provision of sanitation solutions in the world's urban slums is extremely challenging due to lack of money, space, access and sense of ownership. This paper presents a technology selection method that was used for the selection of appropriate sanitation solutions for urban slums. The method used in this paper takes into account sustainability criteria, including social acceptance, technological and physical applicability, economical and institutional aspects, and the need to protect and promote human health and the environment. The study was carried out in Bwaise III; a slum area in Kampala (Uganda). This was through administering of questionnaires and focus group discussions to obtain baseline data, developing a database to compare different sanitation options using technology selection criteria and then performing a multi-criteria analysis of the technology options. It was found that 15% of the population uses a public pit latrine; 75% uses a shared toilet; and 10% has private, non-shared sanitation facilities. Using the selection method, technologies such as Urine Diversion Dry Toilet (UDDT) and biogas latrines were identified to be potentially feasible sanitation solutions for Bwaise III. Sanitation challenges for further research are also presented.

Did the Rabbis Reject the Roman Public Latrine?

Did the Rabbis Reject the Roman Public Latrine?

Tenancy and sanitation provision in informal settlements in Nairobi: revisiting the public latrine option

This paper describes experiences with the construction or improvement of public latrines in three informal settlements in Nairobi – including the type of latrine used and the organization developed for their maintenance and for cost recovery. It also describes why public latrines are the only possible sanitation solution for most such settlements, given the high densities, the high proportion of tenants and the very low incomes. The paper ends with a discussion on what has been learnt from these experiences, including how best to ensure maintenance and revenue generation.

Tenancy and sanitation provision in informal settlements in Nairobi: revisiting the public latrine option

This paper describes experiences with the construction or improvement of public latrines in three informal settlements in Nairobi – including the type of latrine used and the organization developed for their maintenance and for cost recovery. It also describes why public latrines are the only possible sanitation solution for most such settlements, given the high densities, the high proportion of tenants and the very low incomes. The paper ends with a discussion on what has been learnt from these experiences, including how best to ensure maintenance and revenue generation.