Balancing Financial Viability and User Affordability: An Assessment of Six WASH Service Delivery Models

This Topic Brief presents assessments of the financial performance of six WSUP-supported WASH service delivery models in Bangladesh, Madagascar, Mozambique and Zambia. Each model has been developed in partnership with locally mandated service providers to facilitate sustainable, at-scale improvements to low-income urban populations

Urban Sanitation Research Initiative 2017-2020: Driving Sector Change in Urban Sanitation

The Urban Sanitation Research Initiative aims to make a substantive contribution to achieving universal urban sanitation coverage in low-income contexts. This will be achieved through a) direct research-into policy impacts in focus countries, b) contribution to research capacity development in focus countries, and c) contribution to global understanding of how to achieve universal urban sanitation.The research will contribute to the evidence base available to in-country actors including national and city governments, and to major international donors and financing institutions. Research will reflect WSUP's core philosophy that at-scale improvement in urban WASH essentially requires two things: market thinking, including the development of dynamic small businesses in the WASH service delivery sector, and institutional change, including substantially increased government investment in WASH services for low-income communities

Applying a Life-Cycle Costs Approach to Water

This working paper presents findings and recommendations from the application of a life-cycle costs approach (LCCA) to water supply services in rural communities and small towns1 in four countries -- Andhra Pradesh (India), Burkina Faso, Ghana and Mozambique

Out of sight, out of mind:Understanding the sanitation crisis in global South cities

Global monitoring efforts do not provide a clear picture of the challenge of managing human waste at the city scale. Where cities do not provide universal access to publicly managed sanitation systems, households and communities find their own solutions resulting in a patchwork of approaches to removing human waste from places where people live. In dense urban environments, the absence of a coordinated approach can create serious public health problems. In the absence of comparable city-level data, we analyze primary and secondary data from 15 cities and 15 informal settlements in sub-Saharan Africa, South Asia, and Latin America. Across these regions, our study finds that 62 percent of human waste is not safely managed. We also find that, while many cities have a proportion of households connected to sewers, none of the 15 cities safely manage human waste at scale. In the absence of sewers, on-site fecal sludge management systems place enormous responsibility on households and private providers, and unaffordable sanitation options result in risky sanitation practices

PLoS One

Because poor sanitation is hypothesized as a major direct and indirect pathway of exposure to antimicrobial resistance genes (ARGs), we sought to determine a) the prevalence of and b) environmental risk factors for gut carriage of key ARGs in a pediatric cohort at high risk of enteric infections due to poor water, sanitation, and hygiene (WASH) conditions. We investigated ARGs in stool from young children in crowded, low-income settlements of Maputo, Mozambique, and explored potential associations with concurrent enteric pathogen carriage, diarrhea, and environmental risk factors, including WASH. We collected stool from 120 children <14 months old and tested specimens via quantal, multiplex molecular assays for common bacterial, viral, and protozoan enteric pathogens and 84 ARGs encoding potential resistance to 7 antibiotic classes. We estimated associations between ARG detection (number and diversity detected) and concurrently-measured enteric pathogen carriage, recently-reported diarrhea, and risk factors in the child's living environment. The most commonly-detected ARGs encoded resistance to macrolides, lincosamides, and streptogramins (100% of children); tetracyclines (98%); \u3b2-lactams (94%), aminoglycosides (84%); fluoroquinolones (48%); and vancomycin (38%). Neither concurrent diarrhea nor measured environmental (including WASH) conditions were associated with ARG detection in adjusted models. Enteric pathogen carriage and ARG detection were associated: on average, 18% more ARGs were detected in stool from children carrying bacterial pathogens than those without (adjusted risk ratio (RR): 1.18, 95% confidence interval (CI): 1.02, 1.37), with 16% fewer ARGs detected in children carrying parasitic pathogens (protozoans, adjusted RR: 0.84, 95% CI: 0.71, 0.99). We observed gut ARGs conferring potential resistance to a range of antibiotics in this at-risk cohort that had high rates of enteric infection, even among children <14 months-old. Gut ARGs did not appear closely correlated with WASH, though environmental conditions were generally poor. ARG carriage may be associated with concurrent carriage of bacterial enteric pathogens, suggesting indirect linkages to WASH that merit further investigation.P30 ES019776/ES/NIEHS NIH HHS/United StatesP50 ES026071/ES/NIEHS NIH HHS/United States31756196PMC6874316823

High fecal contamination and high levels of antibiotic-resistant enterobacteriaceae in water consumed in the city of Maputo, Mozambique

In the city of Maputo, Mozambique, food and water are often sold on the streets. Street water is packaged, distributed, and sold not paying attention to good hygienic practices, and its consumption is often associated with the occurrence of diarrheal diseases. Coincidentally, the increase of diarrheal diseases promotes the inappropriate use of antibiotics that might cause the emergence of antibiotic-resistant bacterial strains. In this context, the present study aimed to assess the microbiological quality of water sold on the streets of Maputo, as well as the antibiotic resistance profile of selected Enterobacteriaceae isolates. The 118 water samples analyzed were from street home-bottled water (n = 81), municipal water distribution systems (tap water) (n = 25), and selected supply wells in several neighborhoods (n = 12). The samples were analyzed for total mesophilic microorganisms, fecal enterococci, fecal coliforms, Escherichia coli, and Vibrio spp. The results showed a high level of fecal contamination in all types of water samples. In home-bottled water, fecal coliforms were found in 88% of the samples, and E. coli in 66% of the samples. In tap water, fecal coliforms were found in 64%, and E. coli in 28% of the samples. In water from supply wells, fecal coliforms and E. coli were found in 83% of the samples. From 33 presumptive Vibrio spp. colonies, only three were identified as V. fluvialis. The remaining isolates belonged to Aeromonas spp. (n = 14) and Klebsiella spp. (n = 16). Of 44 selected Enterobacteriaceae isolates from water samples (28 isolates of E. coli and 16 isolates of Klebsiella spp.), 45.5% were not susceptible to the beta-lactams ampicillin and imipenem, 43.2% to amoxicillin, and 31.8% to amoxicillin/clavulanic acid. Regarding non-betalactam antibiotics, there was a high percentage of isolates with tolerance to tetracycline (52.3%) and azithromycin (31.8%). In conclusion, water in Maputo represents a risk for human health due to its high fecal contamination. This situation is made more serious by the fact that a relatively high percentage of isolates with multidrug resistance (40%) were found among Enterobacteriaceae. The dissemination of these results can raise awareness of the urgent need to reduce water contamination in Maputo and other cities in Mozambiqueinfo:eu-repo/semantics/publishedVersio

Microbiological assessment of street foods at the point of sale in Maputo (Mozambique)

Objectives: The aim of this study was to assess the microbiological quality and safety of street food sold in the main streets and informal markets of Maputo, the capital of Mozambique. Materials and Methods: From 83 different vendors selling different types of foods, 83 samples of ready-to-eat (RTE) street food were analyzed. Mesophiles, Escherichia coli and total coliforms were used as quality and hygiene indicators. Listeria monocytogenes (L. monocytogenes) Salmonella and coagulase-positive staphylococci were used as food safety indicators. Results: High proportions of unsatisfactory food samples were found in both traditional hot (76.7%) and cold (75%) foods. L. monocytogenes and Salmonella were tested negative in this survey. However, when coagulase-positive staphylococci was used as a food safety indicator, approximately 25% (23/83) of the food samples analyzed were classified as unsatisfactory/ potentially hazardous. Conclusions: These results, showing that street food sold in Maputo clearly requires adequate sanitary conditions for its preparation and sale, contribute to the development of good manufacturing practices (GMP) for street food in Maputo, Mozambique. This is the first report on the microbiological quality and safety of street food in Mozambiqueinfo:eu-repo/semantics/publishedVersio

Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals

The Sustainable Development Goals (SDGs) and the World Bank's corporate goals of ending extreme poverty and boosting shared prosperity call for specific attention to the poor and vulnerable. The overarching objective of the SDGs is to end poverty in all its forms, but their key difference from the earlier Millennium Development Goals (MDGs) is the integration of social, economic, and environmental goals (UN 2015). This has significant implications for reforms aimed at improving service delivery. With this understanding as its guiding compass, the Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic Initiative focuses on what it would take to reduce existing inequalities in WASH services worldwide. This report, a synthesis of that global initiative, offers new insights on how data can be used to inform allocation decisions to reduce inequalities and prioritize investment in WASH to boost human capital. It also offers a fresh perspective on service delivery that considers how institutional arrangements affect the incentives of a range of actors

Design of a Sanitation Risk Assessment for Urban Communities in African Cities

In Africa, the progress to expand access to sanitation services has been slow. A challenge to improving sanitation systems in African cities is a lack of data and reliable information about the existing situation, to plan and prioritise investments. There are limited robust methods to gather data for planning. Conventional methods such as household surveys are time consuming and expensive to undertake, particularly at scale in large cities. Community participation in decision making is widely regarded as essential to achieving sustainable projects, but in urban environments top-down approaches are more common. This research develops and applies a rapid and participatory risk assessment tool to collect baseline data to inform urban sanitation planning and to improve community participation in decision making. The research uses a mixed method approach and participatory action research principles to undertake two case studies in Maputo, Mozambique and Kampala, Uganda. The tool gathers information on sanitation conditions at a local level. The indicators and tool are tested and validated by comparing and triangulating their results with those from conventional household surveys, transect walks and available secondary data. Results show that the tool is easy to use and provides a rapid and cost-effective method to collect data, which provides a good approximation of sanitation risk at a neighbourhood leve