A geographical analysis of the role of water supply and sanitation in the risk of helminth infections of children in West Africa

Background We investigated the geographical variation of water supply and sanitation indicators (WS&S) and their role to the risk of schistosomiasis and hookworm infection in school age children in West Africa. The aim was to predict large-scale geographical variation in WS&S, quantify the attributable risk of S. haematobium, S. mansoni and hookworm infections due to WS&S and identify communities where sustainable transmission control could be targeted across the region. Methods National cross-sectional household-based demographic health surveys were conducted in 24,542 households in Burkina Faso, Ghana and Mali, in 2003–2006. We generated spatially-explicit predictions of areas without piped water, toilet facilities and finished floors in West Africa, adjusting for household covariates. Using recently published helminth prevalence data we developed Bayesian geostatistical models (MGB) of S. haematobium, S. mansoni and hookworm infection in West Africa including environmental and the mapped outputs for WS&S. Using these models we estimated the effect of WS&S on parasite risk, quantified their attributable fraction of infection, and mapped the risk of infection in West Africa. Findings Our maps show that most areas in West Africa are very poorly served by water supply except in major urban centers. There is a better geographical coverage for toilet availability and improved household flooring. We estimated smaller attributable risks for water supply in S. mansoni (47%) compared to S. haematobium (71%), and 5% of hookworm cases could be averted by improving sanitation. Greater levels of inadequate sanitation increased the risk of schistosomiasis, and increased levels of unsafe water supply increased the risk of hookworm. The role of floor type for S. haematobium infection (21%) was comparable to that of S. mansoni (16%), but was significantly higher for hookworm infection (86%). S. haematobium and hookworm maps accounting for WS&S show small clusters of maximal prevalence areas in areas bordering Burkina Faso and Mali smaller. The map of S. mansoni shows that this parasite is much more wide spread across the north of the Niger River basin than previously predicted. Interpretation Our maps identify areas where the Millennium Development Goal for water and sanitation is lagging behind. Our results show that WS&S are important contributors to the burden of major helminth infections of children in West Africa. Including information about WS&S as well as the “traditional” environmental risk factors in spatial models of helminth risk yielded a substantial gain both in model fit and at explaining the proportion of spatial variance in helminth risk. Mapping the distribution of infection risk adjusted for WS&S allowed the identification of communities in West Africa where integrative preventive chemotherapy and engineering interventions will yield the greatest public health benefits.

Estimating the burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa in 2000

Objectives To estimate the burden of disease attributable to unsafe water, sanitation and hygiene (WSH) by age group for South Africa in 2000. Design World Health Organization comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. A scenario-based approach was applied for estimating diarrhoeal disease burden from unsafe WSH. Six exposure scenarios were defined based on the type of water and sanitation infrastructure and environmental faecal-oral pathogen load. For ‘intestinal parasites’ and schistosomiasis, the burden was assumed to be 100% attributable to exposure to unsafe WSH. Setting South Africa. Outcome measures Disease burden from diarrhoeal diseases, intestinal parasites and schistosomiasis, measured by deaths and disability-adjusted life years (DALYs). Results 13 434 deaths were attributable to unsafe WSH accounting for 2.6% (95% uncertainty interval 2.4 - 2.7%) of all deaths in South Africa in 2000. The burden was especially high in children under 5 years, accounting for 9.3% of total deaths in this age group and 7.4% of burden of disease. Overall, the burden due to unsafe WSH was equivalent to 2.6% (95% uncertainty interval 2.5 - 2.7%) of the total disease burden for South Africa, ranking this risk factor seventh for the country. Conclusions Unsafe WSH remains an important risk factor for disease in South Africa, especially in children under 5. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and to promoting safe hygiene behaviours, particularly among children.

Use of permeable reactive barrier to mitigate groundwater nitrate contamination from on-site sanitation

Nearly 50% of India's population depends on variants of pit-toilet systems for human waste disposal. Nitrate contamination of groundwater by pit-toilet leachate is a major environmental concern in the country as it sources a major proportion (50-80%) of potable water from aquifers. Therefore, minimizing nitrate contamination of groundwater due to leachate infiltration from pit-toilet systems is essential. Batch and column experiments demonstrated the capability of bentonite-enhanced sand (BES) specimens to reduce nitrate concentrations in synthetic solutions (initial NO3-N concentration = 22.7 mg/L, C/N = 3) by about 85-90% in 10 to 24 hour by a heterotrophic denitrification process. Based on the laboratory results, it is recommended that use of a BES-permeable reactive barrier layer at the base of pit-toilets will facilitate heterotrophic denitrification and mitigate nitrate contamination of the underlying aquifer.

Comparing the sustainability of an innovative dry sanitation (Ecosan) system in China to a conventional waterborne sanitation system

The use of sustainability indicators for evaluating sanitation systems is applied to the Erdos Eco- Town Project (EETP) in China for illustration. The EETP is the largest urban settlement in the world employing ecological sanitation, which incorporates separation of waste streams, dry toilets, and resource recovery. The EETP’s dry sanitation system is compared against the Dongsheng District’s conventional sewer and centralised STP. The two systems are compared based on technological, environmental, economic, and societal indicators. Overall, the two systems perform reasonably well from a technological perspective. The conventional system performs significantly better than the dry system with regards to land and energy requirements, and global warming potential; it also performs better based on freshwater aquatic and terrestrial ecotoxicity potentials, but by a smaller margin. The dry system has superior environmental performance based on water consumption, eutrophication potential, and nutrient and organic matter recovery. The dry system is a more costly system as it requires greater infrastructure and higher operational costs, and does not benefit from economies of scale. The waterborne system performs better based on the societal indicators largely because it is a well-established system.

The Panama Canal Zone: an epochal event in sanitation

An account of events of the Panama Canal Zone in 1911 by the author, C.F. Adams. (38 page document)

Death or taxes? The political economy of sanitation expenditure in nineteenth-century Britain

This thesis consists of three papers studying the relationship between democratic reform, expenditure on sanitation public goods and mortality in Britain in the second half of the nineteenth century. During this period decisions over spending on critical public goods such as water supply and sewer systems were made by locally elected town councils, leading to extensive variation in the level of spending across the country. This dissertation uses new historical data to examine the political factors determining that variation, and the consequences for mortality rates.

The first substantive chapter describes the spread of government sanitation expenditure, and analyzes the factors that determined towns' willingness to invest. The results show the importance of towns' financial constraints, both in terms of the available tax base and access to borrowing, in limiting the level of expenditure. This suggests that greater involvement by Westminster could have been very effective in expediting sanitary investment. There is little evidence, however, that democratic reform was an important driver of greater expenditure.

Chapter 3 analyzes the effect of extending voting rights to the poor on government public goods spending. A simple model predicts that the rich and the poor will desire lower levels of public goods expenditure than the middle class, and so extensions of the right to vote to the poor will be associated with lower spending. This prediction is tested using plausibly exogenous variation in the extent of the franchise. The results strongly support the theoretical prediction: expenditure increased following relatively small extensions of the franchise, but fell once more than approximately 50% of the adult male population held the right to vote.

Chapter 4 tests whether the sanitary expenditure was effective in combating the high mortality rates following the Industrial Revolution. The results show that increases in urban expenditure on sanitation-water supply, sewer systems and streets-was extremely effective in reducing mortality from cholera and diarrhea.

Socio-cultural influences on sanitation, fish handling and artisanal fish processing within the fishing communities

The fishery sector in Uganda has seen important changes in the last two decades. Among the changes registered, is the expansion of fish markets locally, regionally and internationally. Upon which, remarkable benefits have been realized at local and national levels, for instance, it is estimated that an average of 40m$ is being earned annually as foreign exchange. Besides, presently fish accounts for over 50% of total animal protein in take. However, it is argued that sustaining these gains has become an up hill task due to failure to maintain fish quality as a result of the rudimentary and inappropriate sanitary, fish handling and artisanal fish processing practices that both directly and indirectly affect the quality of fish and fish products. Therefore, against this background, a study of 507 respondents was undertaken among the Lake Victoria Communities specifically in Wakiso, Mayuge and Mukono districts. The study examined the perceptions of fishers on the social cultural practices of sanitation, fish handling and artisanal fish processing and consequently identified factors that influenced these practices.

Aquatic ecology monitoring: water quality, fish, fish catch, sanitation and disease vectors: monitoring No. 5, 6th-9th October 2009

The survey covered by this report was undertaken between 6 th and 9th October 2009 as a follow-up on the during construction surveys of the Bujagali Hydropwer Project (BHPP). In addition to two pre-construction baseline surveys in April 2000 and April 2006, four monitoring surveys have so far been undertaken i.e. in September 2007, April 2008, April 2009 and the present one, in October 2009. The 2009 biannual monitoring surveys were conducted at an upstream and a downstream transect of the BHPP with emphasis on the following aspects: 1. water quality determinants 2. biology and ecology of fishes and food webs 3. fish stock and fish catch including economic aspects of catch and 4. sanitation/vector studies (bilharzias and river blindness)

Aquatic ecology monitoring: water quality, fish, fish catch, sanitation and disease vectors: monitoring no. 8, 6– 10th April 2011

The result reported were from a monitoring survey no.8 undertaken between 6th and 10th April 2011 during construction period of the Bujagali Hydropwer Project (BHPP). Two pre-construction, baseline surveys in April 2000 and April 2006 were conducted and so far,durin construction phase of the project, seven monitoring surveys have been undertaken i.e. in September 2007, April 2008, April 2009,October 2009, April 2010, September 2010 and the present one, in April 2011. Since 2009 biannual monitoring surveys have been conducted at an upstream and a downstream transect of the BHPP with emphasis on the following aspects: Water quality determinants Biology and ecology of fishes and food webs Fish stock and fish catch including economic aspects of catch and Sanitation/vector studies (bilharzias and river blindness)