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      Pit Latrines and Their Impacts on Groundwater Quality: A Systematic Review

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          Abstract

          Background: Pit latrines are one of the most common human excreta disposal systems in low-income countries, and their use is on the rise as countries aim to meet the sanitation-related target of the Millennium Development Goals. There is concern, however, that discharges of chemical and microbial contaminants from pit latrines to groundwater may negatively affect human health.

          Objectives: Our goals were to a) calculate global pit latrine coverage, b) systematically review empirical studies of the impacts of pit latrines on groundwater quality, c) evaluate latrine siting standards, and d) identify knowledge gaps regarding the potential for and consequences of groundwater contamination by latrines.

          Methods: We used existing survey and population data to calculate global pit latrine coverage. We reviewed the scientific literature on the occurrence of contaminants originating from pit latrines and considered the factors affecting transport of these contaminants. Data were extracted from peer-reviewed articles, books, and reports identified using Web of Science SM, PubMed, Google, and document reference lists.

          Discussion: We estimated that approximately 1.77 billion people use pit latrines as their primary means of sanitation. Studies of pit latrines and groundwater are limited and have generally focused on only a few indicator contaminants. Although groundwater contamination is frequently observed downstream of latrines, contaminant transport distances, recommendations based on empirical studies, and siting guidelines are variable and not well aligned with one another.

          Conclusions: In order to improve environmental and human health, future research should examine a larger set of contextual variables, improve measurement approaches, and develop better criteria for siting pit latrines.

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          Most cited references87

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          Water, sanitation and hygiene for the prevention of diarrhoea

          Background Ever since John Snow’s intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality. Methods We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate. Results The striking effect of handwashing with soap is consistent across various study designs and pathogens, though it depends on access to water. The effect of water treatment appears similarly large, but is not found in few blinded studies, suggesting that it may be partly due to the placebo effect. There is very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese. Conclusion We propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the LiST model. Most of the evidence is of poor quality. More trials are needed, but the evidence is nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.
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            Drinking-Water Nitrate, Methemoglobinemia, and Global Burden of Disease: A Discussion

            On behalf of the World Health Organization (WHO), I have undertaken a series of literature-based investigations examining the global burden of disease related to a number of environmental risk factors associated with drinking water. In this article I outline the investigation of drinking-water nitrate concentration and methemoglobinemia. The exposure assessment was based on levels of nitrate in drinking water greater than the WHO guideline value of 50 mg/L. No exposure–response relationship, however, could be identified that related drinking-water nitrate level to methemoglobinemia. Indeed, although it has previously been accepted that consumption of drinking water high in nitrates causes methemoglobinemia in infants, it appears now that nitrate may be one of a number of co-factors that play a sometimes complex role in causing the disease. I conclude that, given the apparently low incidence of possible water-related methemoglobinemia, the complex nature of the role of nitrates, and that of individual behavior, it is currently inappropriate to attempt to link illness rates with drinking-water nitrate levels.
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              Estimating the scope of household water treatment in low- and medium-income countries.

              For populations without reliable access to safe drinking water, household water treatment (HWT) provides a means of improving water quality and preventing disease. We extracted data on reported HWT practices from 67 national surveys and reports on the scope of HWT. An estimated 33.0% of the households (1.1 billion people) in these countries report treating their drinking water at home. The practice is widespread in the Western Pacific (66.8%) and Southeast Asia (45.4%) regions, and it is less common in the Eastern Mediterranean (13.6%) and Africa (18.2%). Boiling is the most dominant method with 21.0% of the study households (598 million people) using the method. Despite being at higher risk of waterborne disease because of lower coverage of improved water sources, African and rural households are less likely to practice HWT or use microbiologically adequate methods. Validation of the household surveys and further analysis of these data could help optimize HWT practices.
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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                22 March 2013
                May 2013
                : 121
                : 5
                : 521-530
                Affiliations
                [1 ]Department of Environmental and Occupational Health, and
                [2 ]Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
                [3 ]Department of Soil Science, North Carolina State University, Raleigh, North Carolina, USA
                Author notes
                Address correspondence to J.P. Graham, School of Public Health and Health Services, Department of Environmental and Occupational Health, George Washington University, Washington, DC 20037 USA. Telephone: (202) 994-2392. E-mail: jgraham@ 123456gwu.edu

                Both authors contributed equally to this article.

                Article
                ehp.1206028
                10.1289/ehp.1206028
                3673197
                23518813
                665714d7-1a78-4c16-9912-62d841ddee7e
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, properly cited.

                History
                : 18 September 2012
                : 11 March 2013
                Categories
                Review

                Public health
                groundwater,latrine,privy,sanitation,siting standards,water quality
                Public health
                groundwater, latrine, privy, sanitation, siting standards, water quality

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