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      Understanding the Barriers and Opportunities for Effective Management of Shared Sanitation in Low-Income Settlements—The Case of Kumasi, Ghana

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          Abstract

          Improved sanitation for all is a daunting task for low-income countries, and shared toilets often provide an alternative to private household sanitation for most urban residents. This study sought to provide better understanding of the existing barriers and opportunities for improved management of shared sanitation. The study used focus group discussions and in-depth interviews with 70 users (landlords and tenants) of shared sanitation in Kumasi, Ghana to assess barriers and opportunities of “high-quality” shared sanitation. The commonly used toilet facilities were dry toilets—Kumasi Ventilated Improved Pit latrine and Ventilated Improved Pit latrines; and flush systems—water closet and pour flush connected to septic tanks. Between 2 and 21 households, or 4 and 84 people, shared one facility. Participants’ description of “high-quality” (Ideal) shared sanitation was centred on cleanliness, user behaviour, smell, and user crowding. They also identified challenges of shared sanitation as overcrowded users, poor user behaviours, conflicts among users, and high cost associated with frequent desludging. However, opportunities for improvement included users’ preference for shared toilets due to enjoyed benefits, existing facility management practices, and mutual understanding among users (tenants and landlords). Interventions and policy guidelines to influence behaviour change of shared sanitation users are proposed and are intended to be delivered by local government and users.

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          Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes

          A systematic review of the literature on the effects of water and sanitation in schools was performed. The goal was to characterize the impacts of water and sanitation inadequacies in the academic environment. Published peer reviewed literature was screened and articles that documented the provision of water and sanitation at schools were considered. Forty-one peer-reviewed papers met the criteria of exploring the effects of the availability of water and/or sanitation facilities in educational establishments. Chosen studies were divided into six fields based on their specific foci: water for drinking, water for handwashing, water for drinking and handwashing, water for sanitation, sanitation for menstruation and combined water and sanitation. The studies provide evidence for an increase in water intake with increased provision of water and increased access to water facilities. Articles also report an increase in absenteeism from schools in developing countries during menses due to inadequate sanitation facilities. Lastly, there is a reported decrease in diarrheal and gastrointestinal diseases with increased access to adequate sanitation facilities in schools. Ensuring ready access to safe drinking water, and hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health. Additional studies that examine the relationship between sanitation provisions in schools are needed to more adequately characterize the impact of water and sanitation on educational achievements.
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            Behaviour change theory and evidence: a presentation to Government

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              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. 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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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                23 June 2020
                June 2020
                : 17
                : 12
                : 4528
                Affiliations
                [1 ]Department of Civil and Environmental Engineering, University of Energy and Natural Resources (UENR), Regional Centre of Energy and Environmental Sustainability (RCEES), P.O. Box 214, Sunyani BS0061, Ghana
                [2 ]Department of Environmental Health & Sanitation Education, University of Education Winneba, Asante-Mampong Campus, P.O. Box 40, Asante-Mampong AM0013, Ghana; dwumfourasare@ 123456gmail.com
                [3 ]Department of Civil Engineering, Regional Water and Environmental Sanitation Centre (RWESCK), Kwame Nkrumah University of Science and Technology (KNUST), PMB, University Post Office, Kumasi AK448, Ghana; kaadjei.soe@ 123456knust.edu.gh
                [4 ]Department of Geography, Kenyatta University, P.O. Box 43844, Nairobi 00100, Kenya; rufmulaa@ 123456gmail.com
                [5 ]Urbanisation and Well-being Unit, African Population & Health Research Center, P.O. Box 10787, Nairobi 00100, Kenya; ssimiyu@ 123456aphrc.org
                Author notes
                Author information
                https://orcid.org/0000-0002-6493-3892
                https://orcid.org/0000-0003-3069-8967
                Article
                ijerph-17-04528
                10.3390/ijerph17124528
                7345014
                32586062
                44c867b9-9d5c-41b8-8be1-a3a107e24347
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 02 April 2020
                : 27 May 2020
                Categories
                Article

                Public health
                barriers,behaviour change,compound,o&m,shared toilet,ghana
                Public health
                barriers, behaviour change, compound, o&m, shared toilet, ghana

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