A tale of two communities: Comparing user perceptions of condominial and conventional sewer systems in Salvador, Brazil

Problems of access and quality of sanitary sewage disproportionately impact the health of populations in urban peripheries of low-and middle-income countries. The condominial sewer system is a practical, low-cost, effective, and simplified engineering approach compared to conventional sewer systems. In support of meeting the sanitation needs in highly populated urban settings, there is a need to understand the residents’ perceptions regarding the advantages and disadvantages of this sanitation model compared to conventional sewer systems. We conducted a cross-sectional study from September to December 2021 in two urban communities of Salvador, Bahia, Brazil, where condominial and conventional sewer systems had been implemented in the last five years. Of the 203 residents we interviewed, 50.7% lived in a site served by a condominial sewer system. Residents in the condominial sewer site reported not connecting to public sewage network (23.7% vs. 11.2%; p = 0.022) more often than in the conventional site. They reported more collective action to solve urban sanitation problems (69.9% vs. 54.0%; p = 0.020), such as manhole cleaning and unclogging efforts to fix plumbing. Despite these challenges, these residents expressed that the current service quality is better than it was in the previous two years. Our results suggest that even within urban periphery communities of a large Brazilian city, disparities exist in access to and quality of sanitation services that may be linked to sewage system implementation. Implementing simplified sewer systems is important to meet the growing sanitation demands of urban areas. However, these systems should also play a role in reducing sanitation disparities and the adoption of participatory approaches to meet the needs of populations in the most disadvantaged conditions. Despite challenging conditions, there is the potential for community engagement and active participation in sanitation-related matters, which could enhance the implementation and long-term sustainability of these systems

Simplified sewerage to prevent urban leptospirosis transmission: a cluster non-randomised controlled trial protocol in disadvantaged urban communities of Salvador, Brazil.

INTRODUCTION: Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved. METHODS AND ANALYSIS: This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400 adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation. ETHICS AND DISSEMINATION: This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities. TRIAL REGISTRATION NUMBER: Brazilian Clinical Trials Registry (RBR-8cjjpgm)