Estimating safely managed sanitation in urban areas; lessons learned from a global implementation of excreta-flow diagrams

The urban population will rise to 6.7 billion by 2050. The United Nations has committed to provide everyone with safely managed sanitation, but there is limited understanding of the scale of the challenge. This paper describes a methodology for rapid assessment of sanitation in cities including a graphical representation (a shit-flow diagram or SFD) and reports on findings from implementation in 39 cities. The SFD provides high level information for planning purposes covering the entire sanitation system in a city. More than half of the human excreta produced in these cities is not safely managed. The most significant portions of the unsafely managed excreta are: (i) contents of pits and tanks which are not emptied and are overflowing, leaking, or discharging to the surrounding environment (14%); (ii) contents of pits and tanks which are emptied but not delivered to treatment (18%); (iii) fecal sludge and supernatant delivered to treatment but not treated (3%); (iv) wastewater in sewers not delivered to treatment (14%); and (v) wastewater delivered to treatment but not treated (6%). Many cities currently relying on onsite sanitation for safe storage, particularly in Africa, will need new strategies as populations grow. Containment systems that discharge to open drains are common in some Asian cities; these pose a public health risk. Dumping of excreta is widespread and there is a lack of realistic performance data on which estimates of the extent and effectiveness of treatment can be made. The SFD production process can be challenging due to a lack of data and low technical capacity in cities. There is often uncertainty over terminology and over the status of infrastructure. Formalizing definitions for the SFD preparation process was found to be useful in overcoming capacity constraints in cities. The SFD produces a credible snapshot of the sanitation situation in a city. The paper provides evidence of the urgent need for improved management and monitoring of urban sanitation in cities around the world and highlights the role of the SFD as a planning tool

Integrating basic urban services for better sanitation outcomes

Rapid urbanization in developing countries demands better integration of planning and delivery of basic services if cities are to be sustainable, healthy and safe. Sanitation improvements are commonly overlooked as investments go towards more visible services such as water supplies and drainage networks. The Sustainable Development Goal for sanitation and hygiene currently remains severely off-track. This paper presents the findings of a Delphi method survey to identify expert consensus on both why and how to integrate sanitation, by which we mean both sewered and non-sewered sanitation services, into other basic urban services (including water supply, drainage, energy and roads) to achieve better sanitation and broader development outcomes, notably for poor citizens. Consensus on why integration is important highlights the physical interdependence of services, where neglect of one service can compromise gains from another investment or service. Consensus on how includes actions to address political priorities and leadership; governance and capacity constraints; clearer planning, procurement and financing mechanisms; and adopting incremental approaches matched to wider urban strategies. It was suggested that achieving these actions would improve accountability, monitoring and service level audits. Experience from previous integrated urban programmes should be incorporated into formulating new sanitation service agreements across all service types. Supported by better-informed dialogue and decision-making between those responsible for urban sanitation and for associated basic services, we suggest integrated and incremental approaches will enable more sustainable urban services planning to achieve ‘quality of life’ outcomes for poor urban residents

Estimating safely managed sanitation in urban areas; lessons learned from a global implementation of excreta-flow diagrams

The urban population will rise to 6.7 billion by 2050. The United Nations has committed to provide everyone with safely managed sanitation, but there is limited understanding of the scale of the challenge. This paper describes a methodology for rapid assessment of sanitation in cities including a graphical representation (a shit-flow diagram or SFD) and reports on findings from implementation in 39 cities. The SFD provides high level information for planning purposes covering the entire sanitation system in a city. More than half of the human excreta produced in these cities is not safely managed. The most significant portions of the unsafely managed excreta are: (i) contents of pits and tanks which are not emptied and are overflowing, leaking, or discharging to the surrounding environment (14%); (ii) contents of pits and tanks which are emptied but not delivered to treatment (18%); (iii) fecal sludge and supernatant delivered to treatment but not treated (3%); (iv) wastewater in sewers not delivered to treatment (14%); and (v) wastewater delivered to treatment but not treated (6%). Many cities currently relying on onsite sanitation for safe storage, particularly in Africa, will need new strategies as populations grow. Containment systems that discharge to open drains are common in some Asian cities; these pose a public health risk. Dumping of excreta is widespread and there is a lack of realistic performance data on which estimates of the extent and effectiveness of treatment can be made. The SFD production process can be challenging due to a lack of data and low technical capacity in cities. There is often uncertainty over terminology and over the status of infrastructure. Formalizing definitions for the SFD preparation process was found to be useful in overcoming capacity constraints in cities. The SFD produces a credible snapshot of the sanitation situation in a city. The paper provides evidence of the urgent need for improved management and monitoring of urban sanitation in cities around the world and highlights the role of the SFD as a planning tool

Data_Sheet_1_Estimating Safely Managed Sanitation in Urban Areas; Lessons Learned From a Global Implementation of Excreta-Flow Diagrams.PDF

The urban population will rise to 6.7 billion by 2050. The United Nations has committed to provide everyone with safely managed sanitation, but there is limited understanding of the scale of the challenge. This paper describes a methodology for rapid assessment of sanitation in cities including a graphical representation (a shit-flow diagram or SFD) and reports on findings from implementation in 39 cities. The SFD provides high level information for planning purposes covering the entire sanitation system in a city. More than half of the human excreta produced in these cities is not safely managed. The most significant portions of the unsafely managed excreta are: (i) contents of pits and tanks which are not emptied and are overflowing, leaking, or discharging to the surrounding environment (14%); (ii) contents of pits and tanks which are emptied but not delivered to treatment (18%); (iii) fecal sludge and supernatant delivered to treatment but not treated (3%); (iv) wastewater in sewers not delivered to treatment (14%); and (v) wastewater delivered to treatment but not treated (6%). Many cities currently relying on onsite sanitation for safe storage, particularly in Africa, will need new strategies as populations grow. Containment systems that discharge to open drains are common in some Asian cities; these pose a public health risk. Dumping of excreta is widespread and there is a lack of realistic performance data on which estimates of the extent and effectiveness of treatment can be made. The SFD production process can be challenging due to a lack of data and low technical capacity in cities. There is often uncertainty over terminology and over the status of infrastructure. Formalizing definitions for the SFD preparation process was found to be useful in overcoming capacity constraints in cities. The SFD produces a credible snapshot of the sanitation situation in a city. The paper provides evidence of the urgent need for improved management and monitoring of urban sanitation in cities around the world and highlights the role of the SFD as a planning tool.</p

Summary of phase II/III double-blind, placebo-controlled trials evaluating onartuzumab in patients with solid tumors.

<p>Bev = bevacizumab, Erl = erlotinib, FOLFOX = oxaliplatin, 5-fluorouracil and folinic acid, GBM = glioblastoma, mCRC = metastatic colorectal cancer, NSCLC = non-small cell lung cancer, Ona = onartuzumab, Pac = paclitaxel, Pbo = placebo, Pem = pemetrexed, Plat = carboplatin or cisplatin, TNBC = triple negative metastatic breast cancer. Data cut-off dates: GO27819: 7 Nov 2013; GO27820: 9 January 2014; GO27821 (Cohort 1): 31 October 2013; GO27821 (Cohort 2): 9 September 2013; GO27827: 6 Feb 2014; OAM4861g: 22 March 2014; OAM4971g: 26 October 2013; YO28252: 29 Jan 2014.</p><p>Summary of phase II/III double-blind, placebo-controlled trials evaluating onartuzumab in patients with solid tumors.</p

Safety of Onartuzumab in Patients with Solid Tumors: Experience to Date from the Onartuzumab Clinical Trial Program

<div><p>Background</p><p>Onartuzumab, a recombinant humanized monovalent monoclonal antibody directed against MET, the receptor for the hepatocyte growth factor, has been investigated for the treatment of solid tumors. This publication describes the safety profile of onartuzumab in patients with solid tumors using data from the global onartuzumab clinical development program.</p><p>Methods</p><p>Adverse event (AE) and laboratory data from onartuzumab phase II/III studies were analyzed and coded into standardized terms according to industry standards. The severity of AEs was assessed using the NCI Common Toxicity Criteria, Version 4. Medical Dictionary for Regulatory Activities (MedDRA) AEs were grouped using the standardized MedDRA queries (SMQs) “gastrointestinal (GI) perforation”, “embolic and thrombotic events, venous (VTE)”, and “embolic and thrombotic events, arterial (ATE)”, and the Adverse Event Group Term (AEGT) “edema.” The safety evaluable populations (patients who received at least one dose of study treatment) for each study were included in this analysis.</p><p>Results</p><p>A total of 773 onartuzumab-treated patients from seven studies (phase II, n = 6; phase III, n = 1) were included. Edema and VTEs were reported in onartuzumab-treated patients in all seven studies. Edema events in onartuzumab arms were generally grade 1–2 in severity, observed more frequently than in control arms and at incidences ranging from 25.4−65.7% for all grades and from 1.2−14.1% for grade 3. Hypoalbuminemia was also more frequent in onartuzumab arms and observed at frequencies between 77.8% and 98.3%. The highest frequencies of all grade and grade ≥3 VTE events were 30.3% and 17.2%, respectively in onartuzumab arms. The cumulative incidence of all grade ATE events ranged from 0−5.6% (grade ≥3, 0−5.1%) in onartuzumab arms. The frequency of GI perforation was below 10% in all studies; the highest estimates were observed in studies with onartuzumab plus bevacizumab for all grades (0−6.2%) and grade ≥3 (0−6.2%).</p><p>Conclusions</p><p>The frequencies of VTE, ATE, GI perforation, hypoalbuminemia, and edema in clinical studies were higher in patients receiving onartuzumab than in control arms; these are considered to be expected events in patients receiving onartuzumab.</p></div

Frequency of low albumin (by laboratory value) in phase II and III studies evaluating onartuzumab.

<p>Bev = bevacizumab, Ona = onartuzumab, Pac = paclitaxel, Pbo = placebo, Pem = pemetrexed.</p><p>^†Not all patients had laboratory values available. Therefore the number in each arm differs from other tables.</p><p>‡Laboratory data from studies GO27819 and OAM4861g were not available at the time of writing.</p><p>Frequency of low albumin (by laboratory value) in phase II and III studies evaluating onartuzumab.</p

Preferred terms reported.

<p>Preferred terms reported.</p

Frequency of arterial thromboembolism (ATE) in phase II and III studies evaluating onartuzumab.

<p>Bev = bevacizumab, Ona = onartuzumab, Pac = paclitaxel, Pbo = placebo, Pem = pemetrexed.</p><p>*Study OAM4861g had 3 arms: Ona + Bev + Pac (n = 62); Ona + Pbo + Pac (n = 58); Pbo + Bev + Pac (n = 62), referred to here as the control arm.</p><p>Frequency of arterial thromboembolism (ATE) in phase II and III studies evaluating onartuzumab.</p