Flush Toilets Research Articles

Private Sanitation and Psychosocial Health in Adolescent Girls

Abstract The relationship between access to private sanitation facilities at home and psychosocial development is documented among adolescents aged 12 to 22 in India and Ethiopia. Obtaining access to private sanitation (flush toilets or pit latrines in the household) is associated with significantly higher self-efficacy and self-esteem for adolescent girls but not boys. Associations are stronger for girls who lived in communities with higher overall access to private sanitation, consistent with the hypothesis that relative access may matter more for psychosocial development than absolute access. There was also a significant correlation with improved peer relations for girls in early (age 12 to 15) but not late (age 19 to 22) adolescence. However, there is no evidence that results are operating through improved physical health or parent relationships.

Comparative life cycle assessment of on-site sanitation systems using lagoons or drying beds for fecal sludge treatment in low-income tropical countries

ABSTRACT Environmental challenges in low-income countries, such as Haiti, persist due to inadequate sanitation infrastructure. This study assesses the environmental impacts of nine on-site sanitation systems to identify those with the least environmental impacts and explore improvement options. Nine scenarios were developed, each representing different systems for managing 1 ton of fecal sludge over 1 year. The ‘Impact World + ’ and ‘IPCC 2013 GWP 100a’ methods evaluated impacts on ecosystems, human health, and climate change. Data sources included interviews, weighing records, and scientific publications. Results show that Scenario 8 (Flush Toilet – Evacuation – Planted Drying Beds) is most impactful on health (1.17 × 10−2 DALY), while Scenario 1 (Composting Toilet – Evacuation – Unplanted Drying Beds) is least impactful (1.77 × 10−3 DALY). For ecosystem impacts, Scenario 2 (Container-based Toilet – Evacuation – Planted Drying Beds) is most impactful (3.81 × 103 PDF·m2·year), while Scenario 6 (VIP latrine – Evacuation – Lagoons) is least impactful (3.52 × 103 PDF·m2·year). Key hotspots include toilet paper, wood shavings, GHG emissions, and water use. The study recommends an integrated approach combining environmental life cycle assessment (LCA) with life cycle cost assessment and social LCA for sustainable decision-making on sanitation systems in low-income countries.

Innovative Energy Design for Energy Efficient Buildings - An Example from the Bullitt Center

In recent years, the extreme climate caused by global warming has brought serious consequences to the world. In order to alleviate the problem of global warming, many scholars have started to analyse energy-saving green buildings. Taking the Bullitt Center as an example, this paper illustrates the innovative applications of energy-efficient buildings in solar power generation, rainwater collection and utilization, toilet water conservation and resource utilization and room temperature regulation. It focuses on the differences in the use of solar power generation in winter and summer, the process of purification of rainwater into water, the comparison between composting toilets and vacuum toilets and the steps of regulating the room temperature by windows and ground-source heat pumps. This paper also talks about the limitations of these innovative applications. It could probably give reference to the subsequent construction of buildings, thus promoting energy saving and emission reduction in buildings and mitigating global warming.

DEVELOPMENT OF EFFICIENT AND ENVIRONMENTALLY FRIENDLY SEPTIC TANKS

In many communities in Indonesia, there are still many areas where their homes do not have a toilet (water closet) that meets hygiene and health requirements. This is caused by many factors, including because there are still many people who live below the poverty line, both economically poor and poor in knowledge (human resources). Procurement of toilets (water closets) which also include a septic tank system with a minimum output that is environmentally friendly and of course cost efficient is very necessary to improve public health. Based on the description above, this research was created in order to provide procurement and development of efficient and environmentally friendly septic tanks. This research is very necessary because of the discovery of an efficient alternative material by using used drums which can be used as septic tanks in Lampung, but it has not deepened the issue of waste output that is safe for the environment. This research was carried out using a constructivist qualitative method with assistance from DIGILIB Digital Library & OPAC UB sources. is at Brawijaya University Malang, where the author is registered as a student in the environmental science doctoral program at Brawijaya University Malang.

Synthesis and functional mechanism evaluation of novel polymer-graphene oxide-biochar nanocomposite for efficient removal of diethyl phthalate

Phthalates, categorized as a main constituent of endocrine-disrupting chemicals (EDCs), are present in polymeric products. These substances can enter the environment through several pathways, including improper handling, which leads to their presence in toilet water, floor washings, surface runoff, and landfill leachate. This study focuses on the performance analysis of nanocomposite materials made of polymer (polypyrrole), quasi-metal (graphene oxide), and biochar (from palmyra seed) for the elimination of diethyl phthalates (DEP) from aqueous environments. Scanning electron microscope (SEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR) were used to describe the nanocomposite characteristics. The experimental results supported a chemisorption process by agreeing well with the pseudo-second order. The Langmuir isotherm explained the DEP sorption data, which aligned to monolayer DEP adsorption on the nanocomposite surface. With a binding affinity of −13.36 (kcal/mol) and the highest docking score, Diethyl phthalates and graphene oxide interaction is validated. The produced nanocomposite is suggested as a possible alternative for the sorption of DEP. Future applications could benefit from the higher adsorption capacity, and environmental friendliness of nanocomposites.

Outstanding Potential for Treating Wastewater from Office Buildings Using Fixed Activated Sludge with Attached Growth Process

The application of fixed activated sludge with an attached growth process (FASAG) with optimal operating conditions (hydraulic retention time (HRT) of 7 h, dissolved oxygen (DO) of 6 mg/L, and alkalinity dosage of 7.14 mgCaCO3/mgN-NH4+) treats wastewater generated from office buildings to meet discharge requirements (as per the regulation in the nation where the study was conducted) with typical parameters such as pH of 6.87–7.56, chemical oxygen demand (COD) of 32–64 mg/L, suspended solids (SS) of 8–11 mg/L, N-NH4+ of 1–7 mg/L, and denitrification efficiency reaches 53%. In addition, the FASAG is an outstanding integration that makes both economic and environmental sense when applied in local wastewater treatment systems. In particular, this process combines aerobic and anoxic processes in a creation tank. This explains why this approach can save investment and operating costs, energy, and land funds. In office building regions, where land area is frequently limited, saving land funds presents numerous options to enhance the density of green cover. Furthermore, as a new aspect, investing in reusing wastewater after treatment to irrigate plants or flush toilets in office buildings contributes to a decrease in the quantity of wastewater released into the environment, saving water resources and supporting sustainable development.

Characterisation of blackwater from human transportation systems equipped with vacuum toilets and controlled emissions tanks and its impact on solid/liquid separation technologies

The first ever detailed characterisation of blackwater from human transportation systems equipped with vacuum toilets and Controlled Emissions Tanks (CET) revealed a stream that is very concentrated in salts and nutrients when compared to other blackwater sources. Escherichia Coli (E. coli) levels in the blackwater characterised were comparatively lower than the range reported for septic tanks, for example. Suspended solids were significantly lower than the levels found in pit latrines, but closely comparable to those reported for gravity toilets. The average COD of 3566 ± 2049 mg/L was typically lower than in pit latrines and gravity flush toilets. These findings then show that the characteristics of the blackwater from human transportation systems are directly impacted by a combination of the low flush vacuum toilets, storage in the CET, and different behaviour for passengers with increased usage for urination over defecation when compared to common uses of toilets. Such factors collectively dictate the nature of the blackwater and require that a solid/liquid separation technology for further processing is fundamentally robust in operation. The greater solids pulverisation, largely resulting from vacuum flushing combined with the storage environment, reduces the suitability of centrifugal and settling technologies whilst making filtration the most suitable option.

Women's toilet use behaviors and water use in a urine diversion squat pan toilet pilot

ABSTRACT Understanding user behavior is critical to the adoption of technology; however, there is a paucity of data related to gender-specific sanitation practices and water-use patterns in toilet use despite the global imperative to increase attention toward the needs of women and girls. This user-focused study sought to understand the role of women's behavior related to the urine diversion performance of a novel toilet design. Forty-one female users of urine diversion toilets installed in two shared bathroom sites in Coimbatore, India, were surveyed about their behavior during toilet use. About 32% of respondents reported behaviors that reduce urine separation efficiency in this system, including aiming urine directly into the hole of the squat pan instead of the ceramic surface (15%); facing backwards (12%); squatting only part way down (7%); and pouring water onto the pan while urinating (5%). Separately, 88% of respondents use available water to clean the floor around the toilet, a practice that may alter the relative volumes of generated blackwater and graywater. These findings may aid the design of future sanitation solutions. Most respondents did not identify the specific toilet design as different from conventional ones, suggesting that these behaviors may apply to broader use cases.

SANITASI RUMAH IBADAH (MASJID) DAN PERILAKU MARBOT MASJID DI KOTA TANJUNGPINANG

It is commonly found that the mosque’s sanitation problems still do not health requirements, for instance, prayer mats are not properly maintained, limited water supply, slippery mossy floor, the absence of water closet, inadequate ventilation and lighting system. The conducted preliminary survey showed that the sanitation condition of the mosque stayed under minimum standard such as scattered garbage in the ditch, inadequate quantity of covered bin, yellowish spots on the ceiling surface, etc. The purpose of this study is to portray the sanitation system of the observed mosques and the behavior of the mosques’ Marbots in Tanjungpinang City. This research is a descriptive survey by conducting observations and interviews, in accordance with Keputusan Menteri Kesehatan Number 288 Year 2003, with 184 of the number of the population, and the number of samples is 65 that were chosen using stratified random sampling technique. The results show that there were 65 (100%) mosques that met the requirement of the condition of the environment and the mosque’s utility, the sanitation system standard was fulfilled by 54 mosques (83,1%), and there were 5 marbots (7,7%) who had good behavior. Hence, it is necessary that the marbots of the mosques might improve their behavior related to the mosques’ sanitation.

Solar powered membrane bioreactor (MBR) treating wastewater for reuse at a hospital in Kampala, Uganda – Results of pilot-scale trials

A robust and cost-effective pilot solar-powered membrane bioreactor (MBR) with downstream granular activated carbon (GAC) filter hospital wastewater treatment was developed for the Lubaga hospital in Kampala, Uganda. The MBR-GAC pilot included a 25 m2 ultrafiltration (UF) module, a 100 kg GAC filter, 20 photovoltaic panels totaling 7 kWp and a 3.55 kWh supercapacitor energy storage unit to produce non-potable and reusable water for toilet flushing, cleaning and irrigation. The pilot operated with 43% clean energy autonomy with grid and diesel generator backup for power outages of more than 1 hour. The MBR pilot produced an average flux of 10–15 L m–2 h–1 with 50% total organic carbon (TOC) removal. The nitrification, denitrification and filtration tanks were separated to achieve a nitrification of 80% and denitrification of 20%. The removal of typical hospital pharmaceutical residues that could not be reduced by the MBR increased to approximately 90% after the downstream GAC filter was upgraded. The removal efficiency of the GAC decreased to approximately 25% at 4,290 bed volume (BV). The significant increase of 75% in the removal efficiency of diclofenac in the MBR was attributed to the acclimation of the activated sludge. The quality of the treated wastewater from the pilot plant was sufficient for reuse by irrigation of the hospital garden, toilet flushing and cleaning. Finally, the study discussed ways to optimize the design and operation of the plant. The pilot is scalable to be replicated elsewhere and adapted in an efficient and cost-effective manner in sub-Saharan countries in Africa.

The impact of COVID-19 national lockdowns on drug-resistant tuberculosis in KwaZulu-Natal, South Africa: A spatial analysis

PurposeWe sought to understand the impact of the initial COVID-19 mitigation strategies in 2020 on drug-resistant (DR) TB diagnoses in KwaZulu-Natal province (KZN), South Africa. MethodsWe compared the number, spatial distribution, and characteristics of DR TB diagnoses before and after the initial COVID-19 lockdown on March 26th, 2020. Information on DR TB diagnoses was collected from the CONTEXT prospective cohort study and municipality characteristics were collected from Statistics South Africa. We used Bayesian conditional autoregressive models and relative-risk surface maps to examine spatial correlates and patterns of DR TB notifications. ResultsBetween October 2018 and February 2022, there were 693 individuals diagnosed with DR TB in KZN, South Africa. The rate of diagnoses per year was 274 and 155 prior and after to the initial lockdowns, respectively, corresponding to a 43 % decrease in the notification rate of cases. Compared to cases diagnosed before the lockdown, cases diagnosed after were less likely to have a fuel source for heating, piped water, a flush toilet, or own a phone (p-values≤0.02). Changes in notifications were not homogenously distributed, with predominantly rural northeastern and southwestern municipalities having significantly greater relative-risks after the lockdown. ConclusionsWe found a reduction in the rate of DR TB diagnoses after the COVID-19 pandemic lockdowns and observed that individuals diagnosed after the lockdowns had worse living conditions, fewer household resources, and more adults living in their household compared to before the pandemic.

Comprehensive agricultural ecological effects of aeration on regenerated liquid fertilizer of mini flush toilet

The high concentration of organic waste liquid obtained from the mini flush pipeline discharge technology based on source separation has the potential for fertilizer utilization. However, there are concerns about the risk of secondary pollution. This study proposes the idea of aeration treatment for regenerated liquid fertilizers to induce beneficial changes in their material composition and properties. Initially, this study compares the characteristic changes in nitrogen transformation of liquid fertilizer through aeration treatment. Subsequently, it examines the effects of different types of liquid fertilizers on soil properties, plant physiology, and soil microbial communities. Finally, we elucidate the flow and distribution of nitrogen in soil, plants, and nitrogen-containing gas emissions in agricultural ecosystems through material flow accounting. The study found that aeration treatment can reduce the ammonia nitrogen ratio while increasing the proportions of nitrite nitrogen and nitrate nitrogen. The regenerated liquid fertilizer through aeration treatment not only significantly increased the chlorophyll, protein, and polysaccharide content of vegetable leaves (P < 0.05) but also reduced nitrate accumulation. Moreover, it can reduce the risk of soil nitrate nitrogen leaching and increase the diversity of soil bacterial communities, enhancing the ecological functions of bacteria involved in carbon and nitrogen cycling. Material flow accounting indicated that aeration treatment for liquid fertilizer could reduce gaseous nitrogen loss by 50.0 %, improve the nitrogen utilization efficiency of vegetables by 95.5 %, and enhance soil nitrogen retention by 11.4 %. Overall, the results show that aeration treatment can improve the agricultural utilization of liquid fertilizer and reduce the risk of secondary pollution, providing preliminary decision-making support for optimizing resource treatment strategies for mini-flush toilet fecal waste to realize the agricultural cycle.

Comparative life cycle assessment of excreta management systems through composting and biomethanization: Case of a low-income tropical country.

Low-income tropical regions, such as Haiti, grapple with environmental issues stemming from inadequate sanitation infrastructure for fecal sludge management. This study scrutinizes on-site sanitation systems in these regions, evaluating their environmental impacts and pinpointing improvement opportunities. The focus is specifically on systems integrating excreta valorization through composting and/or anaerobic digestion. Each system encompasses toilet access, evacuation, and sludge treatment. A comparative life cycle assessment was undertaken, with the functional unit managing one ton of excreta in Haiti over a year. Six scenarios representing autonomous sanitation systems were devised by combining three toilet types (container-based toilets (CBTs), ventilated improved pit (VIP) latrines, and flush toilets (WC)) with two sludge treatment processes (composting and biomethanization). Biodigester-based systems exhibited 1.05 times higher sanitary impacts and 1.03 times higher ecosystem impacts than those with composters. Among toilet types, CBTs had the lowest impacts, followed by VIP latrines, with WCs having the highest impacts. On average, WC scenarios were 3.85 times more impactful than VIP latrines and 4.04 times more impactful than those with CBTs regarding human health impact. Critical variables identified include the use of toilet paper, wood shavings, greenhouse gas emissions, and construction materials.

Retrospective genome-oriented analysis reveals low transmission rate of multidrug-resistant Pseudomonas aeruginosa from contaminated toilets at a bone marrow transplant unit

BackgroundPrevention of toilet-to-patient transmission of multidrug-resistant Pseudomonas aeruginosa (MDR PA) poses management-related challenges at many bone marrow transplant units (BMTU). Using whole-genome sequencing (WGS), we conducted a longitudinal retrospective analysis of the toilet-to-patient transmission rate for MDR PA under existing infection control (IC) measures at a BMTU with persistent MDR PA toilet colonization. MethodsThe local IC bundle comprised 1.) patient education regarding IC, 2.) routine patient screening, 3.) toilet flushing volume of 9L, 4.) bromination of toilet water tanks, and 5.) toilet decontamination using hydrogen peroxide. Toilet water was sampled periodically between 2016-2021 (minimum every three months - 26 intervals). Upon MDR PA detection, disinfection and re-sampling were repeated until ≤ 3 cfu/100ml was reached. WGS was performed retrospectively on all available MDR PA isolates (90 of 117 positive environmental samples, 10 of 14 patients – including nine nosocomial). ResultsWGS of patient isolates identified six sequence types (STs), with ST235/CT1352/FIM-1 and ST309/CT3049/no-carbapenemase being predominant (three isolates each). Environmental sampling consistently identified MDR PA ST235 (65.5% ST235/CT1352/FIM-1), showing low genetic diversity (difference of ≤29 alleles by cgMLST). This indicates that direct toilet-to-patient transmission was infrequent although MDR PA was widespread (detection on 79 occasions, detection in every toilet). Only three MDR PA patient isolates can be attributed to the ST235/CT1352/FIM-1 toilet MRD PA population over six years. ConclusionsGenome-oriented environmental and patient surveillance suggests that the persistent presence of MDR PA poses a potential risk for acquisition, but with stringent targeted toilet disinfection, only three highly vulnerable patients experienced nosocomial transmission.

The impact of information provision on public willingness to use recycled water for flushing from the perspective of risk perception

To solve the current urban water shortage, increasing the willingness of urban residents to use recycled water for flushing is one proposed approach. This study developed a risk perception measurement model of recycled water for toilet flushing to explore which risk triggered people’s risk perception of recycled water, and then analyzed the interaction among information provision, trust, risk perception, and willingness to use recycled water. The main results were as follows. First, the risk perception of recycled water for flushing mainly come from four types of risks, which were performance risk, health risk, service risk and financial risk in order of importance. Second, reducing the perceived risk can improve public willingness to use recycled water for flushing, and greater trust in the water authorities and recycled water enterprises reduces the public’s perception of the risk of recycled water. A higher level of initial trust is related to higher willingness to use recycled water. Third, information provision can enhance the risk perception of recycled water and enhance trust in the water authorities and recycled water enterprises, but information provision does not directly affect the willingness to use recycled water. This indicates that reducing performance risk and health risk of recycled water, will be the key to controlling the overall risk perception of recycled water and promoting willingness to use. Effective risk communication strategies combine information provision and trust in information providers, which together affect risk perception and thus the willingness to use recycled water.

Government transfers, municipal financial performance, and access to improved sanitation in urban South Africa

ABSTRACT This study examines the impact of national government transfers and municipal financial performance on access to sanitation in South Africa. The study uses fixed and random effects models to analyse annual panel data for 35 urban municipalities during the period 2005–20. Results show that municipalities require between R12 200 and R14 300 (about US$714 and US$836) from the national government to provide each household unit with access to a flush toilet. This figure is lower in smaller urban municipalities, which require between R8 404 and R10 205 (about US$492 and US$597). Equally, smaller urban municipalities require fewer surpluses to provide households with flush toilets compared to metropolitan municipalities. These results have implications for the level of national government spending and municipal financial performance needed to address sanitation backlogs. Thus, the study contributes to the ongoing discussion on the feasibility of developing countries attaining SDG 6 targets by 2030.

Integrated treatment of stormwater using multistage filtration (MSF) for domestic application (reuse)

Stormwater harvesting is a promising solution for global freshwater depletion, particularly in tropical regions with abundant rainfall. However, it is not widely used due to the lack of suitable treatment technologies for domestic applications. Multi-stage filtration (MSF) is an effective integrated treatment technology that provides a cost-effective alternative for stormwater treatment. This study investigated MSF's capacity for treating stormwater at different stages. The MSF designed and built comprised the down-flow roughing filter (DRF) and slow sand filter (SSF). The results achieved by the MSF for the treated effluents were: pH (7.1–8.1), temperature (27.6–29.4°C), electrical conductivity (EC) (100–190 µS/cm) and total dissolved solids (TDS) (70–130 mg/L). Turbidity removal efficiency of the MSF was in the range of 36–99% (5.825–164.05 NTU) and the overall average removal efficiency of the MSF was 74%, 90% and 86% for total coliforms (TC) (360–11 800 CFU/100 mL), faecal coliforms (FC) (0–1 300 CFU/100 mL) and Enterococcus spp. (120– 1 400 CFU/100 mL), respectively. The study identified stormwater reuse potentials based on international guidelines and benchmarks. For the treated effluent, pH, temperature, EC and TDS were all within the permissible limits for toilet, laundry, bathing, recreational and agricultural water reuse, while turbidity suited agricultural (non-food crop) and restricted urban reuse. 46% of the effluent was suitable for recreational purposes as this satisfied the 50 NTU standard. 62.5% of the effluent satisfied the FC standard for toilets and urinals and agricultural reuse (non-food crop) purposes, while 87.5 % of the effluent satisfied urban reuse purposes (restricted access). 66.67% of the effluent satisfied the Enterococcus spp. standard for agricultural reuse (non-food crop). All treated effluents satisfied the TC bathing standard. This study shows that after minimal disinfection, stormwater effluents offer potential reuse in household applications, thereby reducing potable water demand.

Family health assessment in Ifugao, Philippines: a baseline study for Health In-tervention Program

A study was conducted to assess the health status of families in selected communities in Ifugao, Philippines. Interviews were done using a guide questionnaire adopted from the Family Health Management Manual for Nursing Students by Lydia Capistrano-Viet. The findings showed that the majority of households are nuclear, consisting of 5–10 people, and have an average monthly family income of 5,000–10,000 Philippine peso. The majority of the families possessed their own lots and homes made of wood and concrete, with enough space for the entire family. The majority of them disposed of their trash by burning it or giving it to animals. Nearly majority of them feature closed drainage systems and flush toilets. The majority reported that their homes lacked bug and rodent breeding grounds and shared a water supply. Additionally, they felt that their families' health was good as they had only experienced colds and the common cold over the previous six months. As shown by the fact that all of the respondents visit doctors and the health center for their medical requirements, 80% of them have complete immunization records. More or less seventy percent of people said they also follow healthy habits. The findings also demonstrate the availability of transportation, communication, and health resources in the neighborhood. A health intervention program aimed at enhancing the health and well-being of family clients in the community will be developed based on the study's findings.

The Interplay Between Household Risk Perception of Parasitic Infections and Water, Sanitation, and Hygiene (WASH) Practices: Evidence From an Urban Poor Community in the Philippines.

Parasitic diseases pose challenges in impoverished urban settlements with limited access to clean water, proper hygiene, and sanitation (WASH). This study assesses WASH practices and risk perceptions of parasitic infections among households in the Bataan Shipyard and Engineering Corporation (BASECO) Compound in Manila, an urban poor community in the Philippines. A cross-sectional study design was employed to collect data through a self-administered questionnaire. Descriptive statistical analysis was performed to assess the sociodemographic profile, household WASH practices, and respondents' risk perception of parasitic infections. Linear regression analysis was utilized to examine the relationship between these variables. A survey was conducted with 363 households, of which 237 (65.3%) used distilled and purified water from the water refilling stations in the community for drinking. Meanwhile, 120 households (33.10%) consumed tap water. Boiling water was a commonly used method (n=146; 56.60%) for treating drinking water. Most households had flush toilets with septic tanks (n=244; 67.20%), water sources for handwashing (n=307; 84.57%) and soap for handwashing (n=356; 98.10%). On average, they washed their hands 6-10 times daily (n=159; 43.80%). Most households were aware that drinking untreated water (n=318; 87.6%), improper food washing (n=309; 85.1%), using contaminated water sources (n=301; 82.9%), and consuming raw or undercooked meat (n=298; 82.1%) could lead to parasitic infections. 316 respondents (87.1%) identified diarrhea as the most common symptom of parasitic infection. Relationships were found between access to drinking water and the number of household members (B=0.191; p-value=0.001), personal hygiene and the respondents' knowledge of parasitic infections (B=0.112; p-value=0.047), and the overall WASH score with household income (B=0.105; p-value=0.045). The WASH conditions in BASECO, Manila need improvement. Factors associated with their WASH practices include risk perception of parasitic diseases, socioeconomic disparity, and household overcrowding. These factors play a crucial role in identifying areas for improvement and promoting health policies for urban poor communities in the Philippines.

Flush toilet use and its impact on health and non‐health expenditures

AbstractThis study analysed the effects of flush toilet use on health and non‐health expenditures incurred by rural Chinese. The instrumental‐variable‐based Tobit and endogenous treatment regression models were used to analyse the 2016 China Labour Force Dynamics Survey data while addressing the selection bias inherent in flush toilet use. The results showed that by improving rural residents' physical and mental health, flush toilet use reduced per capita health expenditure while increasing non‐health expenditure. Furthermore, using flush toilets had positive spillover effects, reducing the health expenditures of even those who did not use them. Factors affecting flush toilet use were also analysed.