Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings

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Abstract.

Shared sanitation is not currently accepted within the international normative definitions of “basic” or “safely managed” sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring.

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The history, geography, and sociology of slums and the health problems of people who live in slums

Alex Ezeh, Oyinlola Oyebode, David Satterthwaite … (2017)

Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.

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Sanitation subsidies. Encouraging sanitation investment in the developing world: a cluster-randomized trial.

Raymond Guiteras, James Levinsohn, Ahmed Mushfiq Mobarak (2015)

Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments-community motivation and information; subsidies; a supply-side market access intervention; and a control-in a cluster-randomized trial. Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, P = 0.43), nor did the supply-side intervention (+0.3 percentage points, P = 0.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, P < 0.001) and their unsubsidized neighbors (+8.5 percentage points, P = 0.001), which suggests that investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (P < 0.001).

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Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes

Marieke Heijnen, Oliver Cumming, Rachel Peletz … (2014)

Background More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines. Methods and Findings Shared sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76). Conclusion Evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.

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Journal

Journal ID (nlm-ta): Am J Trop Med Hyg

Journal ID (iso-abbrev): Am J Trop Med Hyg

Journal ID (publisher-id): tpmd

Journal ID (hwp): tropmed

Title: The American Journal of Tropical Medicine and Hygiene

Publisher: The American Society of Tropical Medicine and Hygiene

ISSN (Print): 0002-9637

ISSN (Electronic): 1476-1645

Publication date (Print): February 2021

Publication date (Electronic): 16 November 2020

Publication date PMC-release: 16 November 2020

Volume: 104

Issue: 2

Pages: 429-432

Affiliations

[1 ]World Vision Inc., Washington, District of Columbia;

[2 ]Harvard Kennedy School of Government, Cambridge, Massachusetts;

[3 ]Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;

[4 ]London School of Hygiene and Tropical Medicine, London, United Kingdom;

[5 ]NHance Development Partners Ltd, Kumasi, Ghana;

[6 ]University of Energy and Natural Resources, Sunyani, Ghana;

[7 ]International Centre for Diarrhoeal Disease Research in Bangladesh, Dhaka, Bangladesh;

[8 ]Temple University, Philadelphia, Pennsylvania;

[9 ]Urban Research, Guildford, United Kingdom;

[10 ]African Population and Health Research Center, Nairobi, Kenya

Author notes

[* ]Address correspondence to James B. Tidwell, World Vision Inc., 300 I St. NE, Washington, DC 20002. E-mail: btidwell@ 123456worldvision.org

Financial Support: This work was partly funded by UKAID through the SHARE Research Consortium.

Authors’ addresses: James B. Tidwell, World Vision Inc., Washington, DC, and Harvard Kennedy School of Government, Havard, MA, E-mail: btidwell@ 123456worldvision.org . Jenala Chipungu, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, E-mail: jenala.chipungu@ 123456cidrz.org . Ian Ross and Oliver Cumming, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: ian.ross@ 123456lshtm.ac.uk and oliver.cumming@ 123456lshtm.ac.uk . Prince Antwi-Agyei, NHance Development Partners Ltd, Kumasi, Ghana, and University of Energy and Natural Resources, Sunyani, Ghana, E-mail: prince.antwi-agyei@ 123456uenr.edu.gh . Mahbub-Ul Alam, International Center for Diarrhoeal Disease Research in Bangladesh, Dhaka, Bangladesh, E-mail: mahbubalam@ 123456icddrb.org . Innocent K. Tumwebaze, Temple University, Philadelphia, PA, E-mail: kamara.innocent@ 123456gmail.com . Guy Norman, Urban Research, Guildford, United Kingdom, E-mail: guy.norman.mail@ 123456gmail.com . Sheillah Simiyu, African Population and Health Research Center, Nairobi, Kenya, E-mail: ssimiyu@ 123456aphrc.org .

Article

Publisher ID: tpmd200985

DOI: 10.4269/ajtmh.20-0985

PMC ID: 7866357

PubMed ID: 33241782

SO-VID: 91b522d3-a5c3-44fc-b370-be85dc3c3218

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 09 August 2020

Date accepted : 29 September 2020

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Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings

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Most cited references 52

The history, geography, and sociology of slums and the health problems of people who live in slums

Sanitation subsidies. Encouraging sanitation investment in the developing world: a cluster-randomized trial.

Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes

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