"Poor and Dirty": Unintended consequences in a hygiene material Distribution in Burkina Faso.

The practical interrelationships between the African environment and hygiene practices during a pandemic period is a topic of significant importance. Specifically, this research explores the intersection of cultural dynamics and hygiene practices in Burkina Faso, focusing on a recent example of distribution of hygiene materials. It highlights the negative reactions to these foreign interventions, perceived as patronizing and stigmatizing, which underscores the complexities of implementing health initiatives in diverse socio-cultural landscapes. These findings stress the importance of culturally sensitive approaches and greater engagement in public health initiatives like the latrine usage with specific designs for communities.

Determinants of Basic Sanitation Service Coverage Among Households in Shashogo District, Hadiya Zone, Central Ethiopia: A Case Control Study.

Background: Basic sanitation services and practices are crucial for the well-being and health of a community. However, little is known about the determinants of basic sanitation services in Ethiopia, particularly in the study area. Objectives: To identify the determinants of basic sanitation service coverage among households in the Shashogo district, Hadiya Zone, and Central Ethiopia in 2023. Methods: A case-control investigation was carried out in households in Shashogo District from August 8, 2023, to December 10, 2023. Ten Kebeles were chosen randomly from a total of 34 Kebeles in the district. A total of 579 households (193 cases and 386 controls) were included in the study. The data were gathered with pretested and structured questionnaires in digital form with a smartphone. The data were analyzed with SPSS. Independent t tests and regression models were used to determine predictors of basic sanitation services. Results: The mean (±SD) age of the study participants was 38.2 (±8.9) years. After controlling for confounders in the multivariate analysis, the adoption of improved latrine services among households was found to be associated with greater average monthly income (AOR = 1.841, 95% CI (1.043, 3.251)), the study respondents who had access to the necessary materials for latrine construction/upgrade were approximately 3.5 times more likely to adopt improved latrine services among households with (AOR = 3.477 (95% CI = 1.314, 9.202) than among those who lacked access to the necessary materials for latrine construction, the study respondents who had training in sanitation and hygiene (AOR = 4.744, 95% CI (2.984, 7.542)) and who had sufficient knowledge about the adoption of improved latrine services (AOR = 2.020, 95% CI (1.125, 3.628)) were found to be determinants of the adoption of improved latrine services among households. Conclusion: This study revealed that economics, knowledge, attitudes and practices, infrastructure, and culture were identified as determinants of the adoption of improved latrines in the study area. Poor sanitation significantly impacts economic, social, environmental and many other direct and indirect impacts on the well-being of citizens. Therefore, policies on sanitation and contextual initiatives and focused actions are needed by stakeholders and policy implementers to improve knowledge gaps, access to necessary materials and the income capacity of those lagging to adopt services.

Prevalence and Determinants of Household Access to Improved Latrine Utilization in Somalia: Health Demographic Survey (SHDS) 2020.

The aim of this research paper is to determine the prevalence of improved household latrine utilization and its determinants in Somalia, using the Somali Health Demographic Survey (SHDS) 2020 dataset. Limited sanitation is a major global problem mainly for the poor and disadvantaged. According to the SHDS 2020 report, around 22.3% of households in Somalia utilize unimproved toilet facilities. In this study, a secondary data analysis was carried out on the SHDS 2020 dataset. The study included 15 826 households weighted for representativeness. Four models were constructed after identifying relevant factors for the outcome variable. The first model, null (empty), had no independent variables. The second model assessed the effect of individual-level determinants on the outcome. The third model determined how community-level variables influenced on the response variable. Finally, a multilevel multivariable logistic regression model examined the combined impact of individual- and community-level factors on the outcome variable. The prevalence of improved latrine utilization in Somalia was (41.1%). The factors: educational status (AOR: 1.899 (1.598, 2.258)), wealth index (AOR: 7.815 (6.990, 8.736)), urban residence (AOR: 2.467 (2.262, 2.690)), households living in various regions/states, including Hirshabelle, Galmudug, Southwest, Puntland, Jubaland, and Somaliland, indicate statistically significant findings and were more likely to utilize improved latrines (AOR: 0.259 (0.229, 0.294)), (AOR: 0.223 (0.196, 0.254)), AOR: 0.196 (0.168, 0.230)), (AOR: 0.220 (0.194, 0.251)), (AOR: 0.204 (0.180, 0.232)), (AOR: 0.086 (0.077, 0.095)). Hirshabelle had a 0.259 times more likelihood of improved latrine utilization than the rest of the regions/states, (AOR: 0.259 (0.229, 0.294)). The prevalence of improved latrine utilization was quite low in Somalia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

An assessment of latrine front-end characteristics and associated surface E. coli indicated faecal contamination in rural Fiji.

In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug-Dec 2019), endline (n = 262) (Jun-Sep 2022) and an in-depth front-end study (n = 12) (Oct-Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.

Psychological and socio-cultural factors affecting latrine ownership and usage in rural South India.

The levels of latrine utilization were lower than the levels of latrine ownership in rural areas owing to certain psycho-social barriers hindering latrine construction and consistent utilization. The study was aimed to identify the proportion of latrine construction and usage and to explore the psychological, socio-cultural and structural factors influencing latrine ownership and utilization. A community-based cross-sectional study was carried out at the four villages of Villupuram district for three months. After IEC clearance, information was collected from a representative sample of 422 households. Direct observation of the latrines was employed along with surveys. The data were entered and analysed in MS Excel. Categorical variables were expressed as frequencies and percentages. Further, the reasons were categorized into psychological, socio-cultural and structural factors. About 54.7% households owned a latrine and among them 46.8% were using it. Psycho-social factors such as convenience, habitual nature, privacy and space constraints in open defecation influenced latrine ownership. Fear of snakes and insects, safety and protection, time saving and proper functioning latrines with availability of water facilitated latrine utilization are of concern. A multi-faceted strategy employing context-specific behaviour change communication along with Government's financial support would improve both latrine construction and utilization.

Personal hygiene practice and associated factors among elementary school students in Fiche Town, Oromia, Ethiopia.

BACKGROUND: Students in school are more likely to be sick from communicable diseases like diarrheal illnesses, acute respiratory infections, and other illnesses linked to poor personal hygiene. Poor hygiene practices are common among school children and put their health at risk, which in turn has several consequences. These include significant school absences, transmission of infectious diseases to other students, and missed workdays for parents and guardians. However, there is limited evidence on the level of personal hygiene practice and its associated factors among school students. Thus, this study was aimed at determining personal hygiene practice level and its associated factors among elementary school grade (5-8) students in Fiche town, Oromia, Ethiopia, in 2022. METHODS: A cross-sectional study design was conducted from April 29 to May 29, 2022, in Fiche town, Oromia regional state, among 534 elementary school students. A multi-stage probability sampling technique was used to select the individual students. A structured questionnaire was used to collect the data. The data was entered into epi-data version 4.6 and analyzed by SPSS version 26.0. Variables that scored a p-value less than 0.2 during bivariate analysis were included in multilevel logistic regression models to determine factors associated with personal hygiene practice. The odds ratio with a 95% confidence interval was estimated, and the level of significance was set at [Formula: see text] 0.05. RESULTS: The magnitude of good personal hygiene (scored above the mean) was 59.2% (95% confidence interval (CI)) (55.1-63.0). A considerable proportion of students scored more than 50% in latrine use (62.5%), regular hand-washing (55.4%), and oral hygiene (55.20%) practices. Being female, having good personal hygiene knowledge, doing hygiene inspections at school, and having latrine accessibility was significantly associated with good personal hygiene among elementary school students. CONCLUSION: Considerable proportion of elementary school students in Fiche town have score poor personal hygiene practice. Interventions aimed that target improving knowledge of personal hygiene and hygiene inspection at school are crucial to enhance the personal hygiene among elementary school students.

Underweight associated with water, sanitation, and hygiene among women of reproductive age in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia.

Ethiopia is one of the sub-Saharan African countries where underweight among women of reproductive age is high, and it is predisposing to low birth weight, preterm birth, and reduced resistance to infections. Poor water, sanitation, and hygiene (WASH) and drinking water polluted with disease-causing microorganisms lead to undernutrition. Therefore, this study aimed to assess the association between WASH and underweight among women of reproductive age at Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. A community-based cross-sectional study was conducted at Arba Minch HDSS, South Ethiopia, from April to May 2022. Women of reproductive age were included in the study. Data were collected using a pre-tested questionnaire and checklist. Multivariate analysis was conducted to assess the association separately for WASH indicators with underweight status of the women by adjusting for sociodemographic characteristics. Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to assess the association. The prevalence of underweight and overweight/obesity among women of reproductive age was 7.82% (95% CI: 5.60, 10.81) and 12.32% (95% CI: 9.50, 15.83), respectively. Latrine hygiene and use were significantly associated with being underweight. The odds of being underweight among those who use clean latrine were 0.43 (95% CI: 0.20, 0.92) compared to those who use unclean latrine or do not have toilet facilities. The utilization of clean latrine facilities is negatively associated with being underweight among women of reproductive age. From WASH components, latrine utilization and keeping the latrine clean to use need to get focused on reducing the risk of being underweight among women of reproductive age.

Compliance of private ventilated improved pit latrines to odour and fly control guidelines: A technical audit in selected regions of Ghana.

The ventilated improved pit (VIP) latrine offers a promising route to safely managed sanitation to many households in developing countries. However, some technical guidelines must be followed in order to realise the technology's advantage of odour and fly nuisance control. This study sought to audit private VIP latrines in selected regions of Ghana to assess their compliance to conventional technical guidelines and to understand the major factors that influence the latrine designs. An inspection checklist was developed to assess 296 private VIP latrines in the Central, Ashanti and Northern Regions of Ghana while semi-structured interviews were conducted among the latrine owners to enquire the factors that influenced the designs of their latrines. The results show that provision of a window in the superstructure (86 %), and the avoidance of an insect screen in the window(s) (77 %) were the most complied guidelines. The use of 150 mm diameter vent pipe was the least satisfied guideline (5 %). On the average, a latrine satisfied about half (3.6) of the technical guidelines that were assessed. The decision or advice of local artisans is the most influential factor in the design of the latrines. Cost was the least mentioned factor cited by the latrine owners. There is the need to establish information desks at the various Metropolitan, Municipal and District Assemblies (MMDAs) to guide prospective owners on the proper design and construction of the VIP latrine. In addition, toilet construction should be incorporated in the curriculum for the basic training of building and construction students in Technical and Vocational Education and Training (TVET) institutions in Ghana. Further research is required to ascertain the basis of the decisions of local artisans and the potential impact of the use of accessories that are 'borrowed' from the WC toilet on odour and fly control in the latrine.

Groundwater implications on methane emission from non-sewered sanitation systems in Nepal.

Non-sewered sanitation systems (NSSS) are identified as significant contributors of greenhouse gases (GHGs), primarily due to biological processes occurring within the containment systems. In unsealed or unlined containment systems like pit latrines, the emissions are influenced by moisture. This work quantified the GHG emission from unlined or unsealed containments prevalent in Nepal and compared it with sealed containment-like septic tanks, where the chances of groundwater (GW) inundation are low. The modeled GW data extracted from the secondary sources were validated with available national data. The emissions were quantified using the Intergovernmental Panel for Climate Change (IPCC) model for different ecological and provincial divisions of Nepal. Spatial representation for the results was done using the Geographical Information System (GIS) tool. The total methane (CH4) emission occurring from the various NSSS was determined to be 2618 Gg CO2 e per year which is almost twice the emission from the waste sector in 2011, as reported by the recent national communication submitted to the United Nations Framework Convention on Climate Change (UNFCC). Variation of the CH4 emission was found to be prominent in lowlands (Terai region) with total national emissions of 1329.37 Gg CO2e per year. The lowland has a shallow GW table that can easily inundate the unlined containments like pit latrines thus contributing to more anaerobic conditions which may lead to higher CH4 emissions compared to containments in mid and highlands. This study concludes that the GHG emissions occurring from NSSS are substantial and addressing these emissions can help fulfil the Nationally Determined Contributions (NDCs) in the waste sector.

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.

Promotion of market-based sanitation in Ethiopia: a case study from Wolaita zone.

Ethiopia increased the availability of latrines notably, but the sanitation facilities rarely meet hygienic standards. Therefore, the market-based sanitation (MBS) programme has been implemented across the country for nearly a decade to expand the market and boost the demand for hygienic sanitation products and services. While it does not seem that the MBS would bring any notable change in sanitation conditions so far, its implementation challenges are not adequately understood. To address this gap, this article delves into the grassroots-level implementation of MBS in the Wolaita zone. The study relies on qualitative data gathered through interviews with various stakeholders, examining both demand- and supply-side challenges. Some issues identified were external to MBS implementation, such as high inflation and an unstable political and security situation in Ethiopia. Additionally, the study reveals that more general deficiencies of the Ethiopian health extension program, including the stress and discouragement of local change agents (health extension workers, health development army members) due to workloads and low remuneration, have adversely impacted MBS delivery. The implementation of MBS has also not effectively addressed the affordability of hygienic sanitation products. On the supply side, economic constraints and organizational inefficiencies have hindered the development of the sanitation market, preventing it from reaching a critical mass. Our research suggests that MBS alone will not suffice to improve sanitation in Ethiopia.

Open Defecation Practice and Its Determinants Among Households Owned Toilet Facilities in Gambela Town, South West Ethiopia.

The use of toilet facilities is a major sanitation intervention, as it reduces the spread of diarrheal diseases. In areas where toilets are misused, human excreta may be disposed of in open fields, bushes, and other open places. However, information about the level of utilization of toilet facilities in developing regions of Ethiopia is limited. Therefore, this study aimed to identify open defecation (OD) levels and determinants of OD among household-owned toilets in Gambella town, Ethiopia. A cross-sectional survey was conducted among 561 households in Gambela Town, using systematic random sampling and questionnaires. The level of OD was analyzed using frequency and percentage. The determinants of OD were assessed using binary logistic regression. Variables with a P-value less than .25 in univariable logistic regression were entered into the multivariable logistic regression model, and statistical significance was declared at a P-value less than .05. The model's fit was tested using Hosmer and Lemeshow's goodness of fit. The study found that OD was 47.2% [95% CI: 43.2%-51.4%] among those who owned toilet facilities. The determinants of OD were: occupation of household head [AOR: 5.27, 95% CI: 3.08-9.00], toilet facilities lacking a superstructure [AOR: 2.0, 95% CI: 1.16-3.43], toilet facilities lacking doors [AOR: 3.23, 95% CI: 1.97-5.27], large family size [AOR: 2.16, 95% CI: 1.29-3.60], knowledge of the respondents [AOR: 2.40, 95% CI: 1.50-3.99], and respondents with negative attitude [AOR: 1.76, 95% CI: 1.12-2.74]. Therefore, key stakeholders should focus on improving toilet utilization, considering those factors in their interventions.

Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh.

BACKGROUND: The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea. METHODS: We conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator. RESULTS: The intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways. DISCUSSION: The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.

Analysis of latrine fecal odor release pattern and the deodorization with composited microbial agent.

As an important source of malodor, the odor gases emitted from public toilet significantly interfered the air quality of living surroundings, resulting in environmental problem which received little attention before. Thus, this paper explored the odor release pattern of latrine feces and deodorization effect with composited microbial agent in Chengdu, China. The odor release rules were investigated in sealed installations with a working volume of 9 L for 20 days. The odor units (OU), ammonia (NH3), hydrogen sulfide (H2S) and total volatile organic compounds (TVOC) were selected to assess the release of malodorous gases under different temperature and humidity, while the highest malodor release was observed under 45℃, with OU and TVOC concentration was 643.91 ± 2.49 and 7767.33 ± 33.50 mg/m3, respectively. Microbes with deodorization ability were screened and mixed into an agent, which composited of Bacillus amyloliquefaciens, Lactobacillus plantarum, Enterococcus faecalis and Pichia fermentans. The addition of microbial deodorant could significantly suppress the release of malodor gas during a 20-day trial, and the removal efficiency of NH3, H2S, TVOC and OU was 81.50 %, 38.31 %, 64.38 %, and 76.86 %, respectively. The analysis of microbial community structure showed that temperature was the main environmental factor driving the microbial variations in latrine feces, while Firmicutes, Actinobacteria, Proteobacteria and Bacteroidetes were the main bacteria phyla involved in the formation and emission of malodorous gases. However, after adding the deodorant, the abundance of Bacteroidetes, Proteobacteria and Actinobacteria were decreased, while the abundance of Firmicutes was increased. Furthermore, P. fermentans successfully colonized in fecal substrates and became the dominant fungus after deodorization. These results expanded the understanding of the odor release from latrine feces, and the composited microbial deodorant provided a valuable basis to the management of odor pollution.

Understanding Households' Willingness to Pay for Improved Sanitation Services in Benin: A Study Protocol.

Nowadays, in Benin, latrine construction by households highly depends on their financial contributions. However, empirical evidence shows that many households are unwilling to invest in adequate sanitation services. The study aims to determine the household's willingness to pay for improved sanitation services and the associated factors. The study population will include households lacking unimproved sanitation facilities. The household heads will be eligible for survey participation. We will perform a contingent valuation to determine households' willingness to pay for a Ventilated Improved Pit (VIP) latrine. Following a description of the surveyed population, we will assess willingness to pay using the 'doubleb' command in Stata. Subsequently, we will conduct multivariate logistic regression to determine the factors associated with willingness to pay. The expected results will be: a description of the basic characteristics of households without improved sanitation services, an estimation of household willingness to pay for VIP latrines using the contingent valuation, and factors associated with household willingness to pay for VIP latrines. This study will contribute to the literature on household demand for improved sanitation services in Benin.

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling.

Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.

Development of a behaviour change intervention to promote sanitation and latrine use in rural India.

BACKGROUND: Across developing countries poor sanitation is associated with disease often found widespread in rural populations. OBJECTIVES: This objective of this study was to conduct a formative research and feasibility evaluation of the behavioural intervention designed to improve latrine use in rural India. METHODS: Study conducted in four villages of Rajasthan, where latrine use is low and open defecation may spread disease. To identify the intervention a literature review was conducted, a survey of 497 households, and focus groups in village households (8-10 women and children). Seven focus groups with 63 women were conducted. Based on the survey results, the behaviour change intervention is developed utilising the Capability-Opportunity-Motivation-behaviour model and MINDSPACE framework. One intervention component involves psychological aspects that engage villagers through a pledge; the other component is provision of small incentives to facilitate latrine use. Feasibility and acceptability of the intervention was examined in the study population. The 30-day intervention was delivered to women in 38 randomly selected households who despite having a functional latrine did not use it. Thematic analysis, binary logistic regression analysis and feasibility evaluation of the intervention conducted. Post-intervention feedback from 22 participating households was obtained. RESULTS: The piloted intervention was feasible and so a revised design is offered. Results driving this evaluation include barriers identified, and used to improved intervention design in the current study. Village authority figures influenced behaviours across the villages and so did factors of convenience (ß = 5.28, p < 0.01), relief (ß = 5.49, p < 0.01), comfort (ß = 2.36, p < 0.01), Construction cost (ß=-1.98, p < 0.01) and safety (ß = 2.93, p < 0.01) were significant concerns associated with latrine use in the context of prevalent OD in the region. The logistic regression baseline model for the dependant variables indicated a significant increase in latrine use. Based on the feasibility study, the intervention is refined in several ways. CONCLUSIONS: Our theory-driven approach improves latrine use in Rajasthan and offers a useful tool to facilitate hygiene behaviour.

Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya.

OBJECTIVES: Innovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low-income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub-county and HCF level. METHODS: At baseline (pre-intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in-charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference-in-difference analysis compared changes from baseline to endline in patient-reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient-reported acceptability following use of SaTo pan versus non-SaTo pan latrines within intervention HCFs. RESULTS: Patient-reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient-reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between-arm difference-in-difference was not significant. Enumerator-observed odour declined in intervention latrines (32%-14%) compared with controls (36%-51%, difference-in-difference ratio: 0.32, 95% confidence interval: 0.12-0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient-reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported. CONCLUSIONS: Our results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed.

Exploration of appropriate media to influence sustainable on-site sanitation choices in Sri Lanka- visualization with still images or a video.

Pit latrines are the most common form of improved sanitation in many rapidly developing countries. However, they cause the highest amount of groundwater pollution among on-site sanitation (OSS) facilities. Many households in developing countries use groundwater as their main or sub-source, and pit latrines are not a sustainable solution. Thus, the conversion from pit latrines to septic tanks is required. We created two types of media, still images and a video, to illustrate the differences in functions and hygiene risks between pit latrines and septic tanks. Moreover, a survey was conducted in Sri Lanka to determine the media choice that would increase the people's preference for septic tanks as their next OSS, even weeks after the information is presented. The choice of the next OSS participants selected before they were presented with the images was the same as that currently in use, reflecting the belief that the problem of pit latrines was not currently apparent and need not be changed. However, a video presentation of the information made it possible for a larger group of people to choose the usage of septic tanks in the future, especially in suburban areas where the problems were likely to occur.

Urban Sanitation: New Terminology for Globally Relevant Solutions?

Progress toward Sustainable Development Goals for global access to safe sanitation is lagging significantly. In this Feature, we propose that misleading terminology leads to errors of categorization and hinders progress toward sanitation service provision in urban areas. Binary classifications such as "offsite/onsite" and "sewered/nonsewered" do not capture the need for "transport to treatment" or the complexity of urban sanitation and should be discarded. "Fecal sludge management" is used only in the development context of low- or middle-income countries, implying separate solutions for "poor" or "southern" contexts, which is unhelpful. Terminology alone does not solve problems, but rather than using outdated or "special" terminology, we argue that a robust terminology that is globally relevant across low-, middle-, and upper-income contexts is required to overcome increasingly unhelpful assumptions and stereotypes. The use of accurate, technically robust vocabulary and definitions can improve decisions about management and selection of treatment, promote a circular economy, provide a basis for evidence-based science and technology research, and lead to critical shifts and transformations to set policy goals around truly safely managed sanitation. In this Feature, the three current modes of sanitation are defined, examples of misconceptions based on existing terminology are presented, and a new terminology for collection and conveyance is proposed: (I) fully road transported, (II) source-separated mixed transport, (III) mixed transport, and (IV) fully pipe transported.