Centralized or Onsite Testing? Examining the Costs of Water Quality Monitoring in Rural Africa.

Rural water systems in Africa have room to improve water quality monitoring. However, the most cost-effective approach for microbial water testing remains uncertain. This study compared the cost per test (membrane filtration) of four approaches representing different levels of centralization: (i) one centralized laboratory serving all water systems, (ii) a mobile laboratory serving all systems, (iii) multiple semi-centralized laboratories serving clusters of systems, and (iv) decentralized analysis at each system.

The Impact of Pro-Poor Sanitation Subsidies in Open Defecation-Free Communities: A Randomized, Controlled Trial in Rural Ghana.

Background: According to the World Health Organization/United Nations International Children's Fund Joint Monitoring Program, people practice open defecation globally. After achieving open defecation-free (ODF) status through efforts such as Community-Led Total Sanitation (CLTS), communities (particularly vulnerable households) may revert to open defecation, especially when toilet collapse is common and durable toilets are unaffordable. Accordingly, there is increasing interest in pro-poor sanitation subsidies.

Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana.

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g.

Will Households Invest in Safe Sanitation? Results from an Experimental Demand Trial in Nakuru, Kenya.

Unsafe sanitation is an increasing public health concern for rapidly expanding cities in low-income countries. Understanding household demand for improved sanitation infrastructure is critical for planning effective sanitation investments. In this study, we compared the stated and revealed willingness to pay (WTP) for high-quality, pour-flush latrines among households in low-income areas in the city of Nakuru, Kenya.

Where Does CLTS Work Best? Quantifying Predictors of CLTS Performance in Four Countries.

Improving the effectiveness of rural sanitation interventions is critical for meeting the United Nations' Sustainable Development Goals and improving public health. Community-led total sanitation (CLTS) is the most widely used rural sanitation intervention globally; however, evidence shows that CLTS does not work equally well everywhere. Contextual factors outside the control of implementers may partially determine CLTS outcomes, although the extent of these influences is poorly understood.

How Much Will Safe Sanitation for all Cost? Evidence from Five Cities.

Global sustainable development goals call for universal access to safely managed sanitation by 2030. Here, we demonstrate methods to estimate the financial requirements for meeting this commitment in urban settings of low-income countries. Our methods considered two financial requirements: (i) the subsidies needed to bridge the gap between the willingness-to-pay of low-income households and actual market prices of toilets and emptying services and (ii) the amounts needed to expand the municipal waste management infrastructure for unserved populations.

What Environmental Factors Influence the Concentration of Fecal Indicator Bacteria in Groundwater? Insights from Explanatory Modeling in Uganda and Bangladesh.

Information about microbial water quality is critical for managing water safety and protecting public health. In low-income countries, monitoring all drinking water supplies is impractical because financial resources and capacity are insufficient. Data sets derived from satellite imagery, census, and hydrological models provide an opportunity to examine relationships between a suite of environmental risk factors and microbial water quality over large geographical scales.

When pits fill up: Supply and demand for safe pit-emptying services in Kisumu, Kenya.

Improving sanitation conditions in low-income communities is a major challenge for rapidly growing cities of the developing world. The expenses and logistical difficulties of extending sewerage infrastructure have focused increasing attention on the requirements for safe and cost-effective fecal sludge management services. These services, which are primarily provided by the private sector, include the collection and treatment of fecal waste from latrine pits and septic tanks.

Assessing the Demand for Plastic Latrine Slabs in Rural Kenya.

Improving access to safe and affordable sanitation facilities is a global health priority that is essential for meeting the United Nation's Sustainable Development Goals. To promote the use of improved sanitation in rural and low-income settings, plastic latrine slabs provide a simple option for upgrading traditional pit latrines. The International Finance Corporation/World Bank Selling Sanitation program estimated that plastic slabs would have a 34% annual growth, with a market size of US$2.

Are Presence/Absence Microbial Tests Appropriate for Monitoring Large Urban Water Supplies in Sub-Saharan Africa?

Screening for fecal contamination via microbial water quality monitoring is a critical component of safe drinking water provision and public health protection. Achieving adequate levels of microbial water quality testing, however, is a challenge in resource-limited settings. One strategy for addressing this challenge is to improve the efficiency of monitoring programs.

Why do water quality monitoring programs succeed or fail? A qualitative comparative analysis of regulated testing systems in sub-Saharan Africa.

Background: Water quality testing is critical for guiding water safety management and ensuring public health. In many settings, however, water suppliers and surveillance agencies do not meet regulatory requirements for testing frequencies. This study examines the conditions that promote successful water quality monitoring in Africa, with the goal of providing evidence for strengthening regulated water quality testing programs.

The effect of sodium thiosulfate dechlorination on fecal indicator bacteria enumeration: laboratory and field data.

In microbiological water quality testing, sample dechlorination with sodium thiosulfate is recommended to ensure that results accurately reflect the water quality at sample collection. Nevertheless, monitoring institutions in low-resource settings do not always dechlorinate samples, and there is limited research describing how this practice impacts drinking water quality results. The effect of dechlorination on indicator bacteria counts was evaluated by spiking laboratory water with five Escherichia coli (E.

Efficacy of microbial sampling recommendations and practices in sub-Saharan Africa.

Current guidelines for testing drinking water quality recommend that the sampling rate, which is the number of samples tested for fecal indicator bacteria (FIB) per year, increases as the population served by the drinking water system increases. However, in low-resource settings, prevalence of contamination tends to be higher, potentially requiring higher sampling rates and different statistical methods not addressed by current sampling recommendations. We analyzed 27,930 tests for FIB collected from 351 piped water systems in eight countries in sub-Saharan Africa to assess current sampling rates, observed contamination prevalences, and the ability of monitoring agencies to complete two common objectives of sampling programs: determine regulatory compliance and detect a change over time.

Supply and Demand for Improved Sanitation: Results from Randomized Pricing Experiments in Rural Tanzania.

Improving access to sanitation is a global public health priority. Sufficient consumer demand is required for sanitation coverage to expand through private provision. To measure consumer demand for hygienic latrine platform products in rural Tanzania, we conducted a randomized, voucher-based real-money sales trial with 1638 households with unimproved latrines.

How Much Will It Cost To Monitor Microbial Drinking Water Quality in Sub-Saharan Africa?

Microbial water quality monitoring is crucial for managing water resources and protecting public health. However, institutional testing activities in sub-Saharan Africa are currently limited. Because the economics of water quality testing are poorly understood, the extent to which cost may be a barrier to monitoring in different settings is unclear.

Can Sanitary Surveys Replace Water Quality Testing? Evidence from Kisii, Kenya.

Information about the quality of rural drinking water sources can be used to manage their safety and mitigate risks to health. Sanitary surveys, which are observational checklists to assess hazards present at water sources, are simpler to conduct than microbial tests. We assessed whether sanitary survey results were associated with measured indicator bacteria levels in rural drinking water sources in Kisii Central, Kenya.

Assessing Drinking Water Quality and Water Safety Management in Sub-Saharan Africa Using Regulated Monitoring Data.

Universal access to safe drinking water is prioritized in the post-2015 Sustainable Development Goals. Collecting reliable and actionable water quality information in low-resource settings, however, is challenging, and little is known about the correspondence between water quality data collected by local monitoring agencies and global frameworks for water safety. Using 42 926 microbial water quality test results from 32 surveillance agencies and water suppliers in seven sub-Saharan African countries, we determined the degree to which water sources were monitored, how water quality varied by source type, and institutional responses to results.

Assessing the Association between Thermotolerant Coliforms in Drinking Water and Diarrhea: An Analysis of Individual-Level Data from Multiple Studies.

Background: Fecally contaminated drinking water is believed to be a major contributor to the global burden of diarrheal disease and a leading cause of mortality among young children. However, recent systematic reviews and results from blinded studies of water quality interventions have raised questions about the risk associated with fecally contaminated water, particularly as measured by thermotolerant coliform (TTC) bacteria, a WHO-approved indicator of drinking water quality.

Objectives: We investigated the association between TTC in drinking water and diarrhea using data from seven previous studies.

Urban Water Services in Fragile States: An Analysis of Drinking Water Sources and Quality in Port Harcourt, Nigeria, and Monrovia, Liberia.

Establishing and maintaining public water services in fragile states is a significant development challenge. In anticipation of water infrastructure investments, this study compares drinking water sources and quality between Port Harcourt, Nigeria, and Monrovia, Liberia, two cities recovering from political and economic instability. In both cities, access to piped water is low, and residents rely on a range of other private and public water sources.

To What Extent is Drinking Water Tested in Sub-Saharan Africa? A Comparative Analysis of Regulated Water Quality Monitoring.

Water quality information is important for guiding water safety management and preventing water-related diseases. To assess the current status of regulated water quality monitoring in sub-Saharan Africa, we evaluated testing programs for fecal contamination in 72 institutions (water suppliers and public health agencies) across 10 countries. Data were collected through written surveys, in-person interviews, and analysis of microbial water quality testing levels.

Interventions to improve water quality for preventing diarrhoea.

Background: Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes).

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa.

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies.

Shared sanitation versus individual household latrines: a systematic review of health outcomes.

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.

Water, sanitation, and hygiene interventions to improve health among people living with HIV/AIDS: a systematic review.

Design: People living with HIV/AIDS (PLHIV) are at increased risk of diarrhoeal disease and enteric infection. This review assesses the effectiveness of water, sanitation, and hygiene (WASH) interventions to prevent disease among PLHIV.

Methods: We searched MEDLINE, EMBASE, Global Health, The Cochrane Library, Web of Science, LILACS, Africa-wide, IMEMR, IMSEAR, WPRIM, CNKI, and WanFang.