Faecal sludge emptying in Sub-Saharan Africa, South and Southeast Asia: A systematic review of emptying technology choices, challenges, and improvement initiatives

The emptying and transport of faecal sludge (FS) is a fundamental aspect of the sanitation service chain and is mostly carried out by private operators who usually face a lot of challenges. Our review assessed how influencing factors and challenges FS emptiers face are linked and in turn how they act as barriers to improvement initiatives. We conducted a systematic review of peer-reviewed journals on FS emptying in sub-Saharan Africa, South and Southeast Asia published between January 2002 and December 2021. Amongst the 37 journals reviewed, accessibility was mostly documented (n = 18) as a factor which affected choice of emptying method, followed by cost (n = 14), quality of service (n = 13) and then sludge thickness (n = 8). We grouped the types of challenges identified from the publications into five categories of financial, technical and institutional (n = 14, each), followed by health (n = 12) and then social challenges (n = 8). Discussions on initiatives (n = 13) used to improve the emptying business were limited to Cost/affordability of sanitation services and access to finance by FS emptiers, which were noted to be the major barriers to effective implementation of these strategies. This review identified the need for sensitizing the public on FS emptying, financial modelling of manual emptying business and a need to study the relationship between perceptions and emptying behavior of users

Mortality pattern among tuberculosis patients on treatment in Nigeria: A systematic review and meta-analysis

Background: Tuberculosis (TB) has continued to be associated with a substantial number of deaths, even in the era of effective antimicrobials. Nigeria is one of the countries with a high tuberculosis burden and has sub-optimal documentation of TB related deaths. Vital statistics/registration is not robust, and mortality surveys are rarely undertaken. In this study, we aimed to determine a precise estimate of TB related deaths on treatment and the trends in death rate while on TB treatment in Nigeria. Methods: We searched electronic databases for eligible studies from 1st January 2000 to 31st December 2017. We generated pooled death rate estimates using random-effects models and determined trends using meta-regression. Results: We identified 546 studies, of which 28 fulfilled the criteria for quantitative analysis. Overall, studies reported on 64,999 individuals. The pooled TB death rate during treatment was 6.6% (95% CI; 5.2-8.1%). There was a non-significant rise in TB related deaths on treatment of 0.2% per year (p-value = 0.454). Conclusion: We found a low TB related deaths on treatment, death rate and slight temporal rise over the study years. There is a need for continuous vital registration, including TB related death, and mortality survey among TB patients

Effectiveness of the Swachh Bharat Mission and barriers to ending open defecation in India: a systematic review

In 2016, nearly 60% of the population of India practiced open defecation (OD), which was 4 times the global rate, and reducing OD in India will be essential in meeting Sustainable Development Goal (SDG) 6.2 and improving global public health. The government of India launched the Swachh Bharat Mission (SBM) in 2014 with one key goal for all Indian states to achieve OD-free (ODF) status by 2019. Despite reports from the Government of India on the success of SBM, the true ODF status of Indian states is still unknown. A systematic review of peer-reviewed literature was conducted to assess the impact of SBM on OD in India, evaluate the barriers to reducing OD, and provide recommendations for future interventions to reduce or eliminate OD in India. A total of 237 publications were screened, and 22 were selected for inclusion. While the Prime Minister declared India ODF in 2019, studies suggest that the government monitoring system overestimates numbers of ODF villages and toilet coverage. Reasons for households’ continued OD practice include financial constraints, lack of water supply, governmental mistrust, cultural beliefs, and personal preference. Community incentives and penalties have been used to encourage proper sanitation practices with varying success. Overarching strategies and approaches that have worked well across study districts to reduce OD include high involvement of district leadership and innovative behavior-change and local community mobilization campaigns

Recycling of Faecal Sludge: Nitrogen, Carbon and Organic Matter Transformation during Co-Composting of Faecal Sludge with Different Bulking Agents

This study investigated the effect of locally available bulking agents on the faecal sludge (FS) composting process and quality of the final FS compost. Dewatered FS was mixed with sawdust, coffee husk and brewery waste, and composted on a pilot scale. The evolution of physical and chemical characteristics of the composting materials was monitored weekly. Results indicate that bulking agents have a statistically significant effect (p < 0.0001) on the evolution of composting temperatures, pH, electrical conductivity, nitrogen forms, organic matter mineralisation, total organic carbon, maturity indices, quality of the final compost and composting periods during FS composting. Our results suggest reliable maturity indices for mature and stable FS compost. From the resource recovery perspective, this study suggests sawdust as a suitable bulking agent for co-composting with FS—as it significantly reduced the organic matter losses and nitrogen losses (to 2.2%), and improved the plant growth index, thus improving the agronomic values of the final compost as a soil conditioner. FS co-composting can be considered a sustainable and decentralised treatment option for FS and other organic wastes in the rural and peri-urban communities, especially, where there is a strong practice of reusing organic waste in agriculture

Biochar and Its Potential Application for the Improvement of the Anaerobic Digestion Process: A Critical Review

Poor management of organic waste is a key environmental and public health issue as it contributes to environmental contamination and the spread of diseases. Anaerobic digestion (AD) presents an efficient method for organic waste management while generating energy and nutrient-rich digestate. However, the AD process is limited by key factors, which include process inefficiencies from substrate-induced instability, poor quality digestate, and poor management of effluent and emissions. Lately, there has been more interest in the use of biochar for improving anaerobic digestion. Biochar can improve methane production by speeding up the methanogenesis stage, protecting microorganisms from toxic shocks, and reducing inhibition from ammonia and volatile fatty acids. It can be applied for in situ cleanup of biogas to remove carbon dioxide. Applying biochar in AD is undergoing intensive research and development; however, there are still unresolved factors and challenges, such as the influence of feedstock source and pyrolysis on the performance of biochar when it is added to the AD process. In light of these considerations, this review sheds more light on various potential uses of biochar to complement or improve the AD process. This review also considers the mechanisms through which biochar enhances methane production rate, biochar’s influence on the resulting digestate, and areas for future research

Urban and rural sanitation in the Solomon Islands:How resilient are these to extreme weather events?

The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 (“by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation”). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative cross-sectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders

Application of black soldier fly larvae in decentralized treatment of faecal sludge from pit latrines in informal settlements in Kampala city

Introduction: Faecal sludge management (FSM) in urban areas of low-and middle-income countries (LMICs) is not properly implemented due to inaccessibility of sanitation facilities and high faecal sludge (FS) emptying costs, amongst others. Unlike in solid waste and fresh human excreta, use of black soldier fly larvae (BSFL) in treatment of FS from pit latrines - which are the most common sanitation facilities in urban areas of LMICs - has not yet been explored. Moreover, the optimal conditions for efficient FS degradation, such as moisture content, feeding rate and larval density are not yet well known. Against this backdrop, the overarching aim of this study was to determine the effectiveness of BSFL in treating FS under different conditions of moisture content, feeding rate and larval density. Also, the quality of residue left after treatment was assessed.Methods: FS samples were collected from lined and unlined pit latrines in Bwaise I parish in Kampala, Uganda and experiments were set up to feed 10-day old larvae.Results and Discussion: The optimum feeding rate, larval density and moisture content were found to be 50 mg/larvae/day, 1.33 larvae/cm2 and 60%, respectively. The reduction efficiency at optimum conditions were 72% and 66% for FS from lined and unlined pit latrines, respectively. It was further noted that BSFL can feed on FS from pit latrines without dewatering it, hence there is no need for a dewatering unit. The properties of the residue left after treatment were within the allowable limit for use as compost except for helminth egg concentration. Thus, in informal urban settlements, BSFL can be applied for effective treatment of FS from pit latrines while generating good quality residue thereby providing an additional value chain in FSM

Capacity Building for Primary Stroke Prevention Teams in Children Living With Sickle Cell Anemia in Africa

Background: Nigeria has the highest proportion of children with sickle cell anemia (SCA) globally; an estimated 150,000 infants with SCA are born annually. Primary stroke prevention in children with SCA must include Nigeria. We describe capacity-building strategies in conjunction with two National Institutes of Health–funded primary stroke prevention trials (a feasibility trial and phase III randomized controlled trial) with initial hydroxyurea treatment for children with SCA and abnormal transcranial Doppler (TCD) velocities in Nigeria. We anticipated challenges to conducting clinical trials in a low-resource setting with a local team that had not previously been involved in clinical research and sought a sustainable strategy for primary stroke prevention. Methods: This is a descriptive, prospective study of challenges, solutions, and research teams in two trials that enrolled a total of 679 children with SCA. Results: As part of the capacity-building component of the trials, over eight years, 23 research personnel (physicians, nurses, research coordinators, a statistician, and a pharmacist) completed a one-month research governance and ethics training program at Vanderbilt University Medical Center, USA. A lead research coordinator for each site completed the Society of Clinical Research Professionals certification. TCD machines were donated; radiologists and nonradiologists were trained and certified to perform TCD. A scalable E-prescription was implemented to track hydroxyurea treatment. We worked with regional government officials to support ongoing TCD-based screening and funding for hydroxyurea for children with SCA at a high risk of stroke. Conclusions: Our trials and capacity building demonstrate a sustainable strategy to initiate and maintain pediatric SCA primary stroke prevention programs in Africa

Urban and rural sanitation in the Solomon Islands: How resilient are these to extreme weather events?

The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 (“by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation”). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative cross-sectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders

Invasive Fungal Diseases in Africa: A Critical Literature Review

Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy