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Alternative Sanitation in Protracted Emergencies
In 2014 CDC were awarded an R2HC grant with the objective of determining the safety and acceptability of urine-diversion dry toilets (UDDTs) in refugee camp settings to provide guidance on their use in humanitarian crises. UDDTs can potentially be an effective sanitation option in difficult environments where pit latrines are not feasible. The focus is on UDDTs implemented in a refugee camp in Dollo Ado, Ethiopia, but may be applicable to other settings where flooding or poor soil conditions prevent the use of pit latrines.
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Principal Investigator: Thomas Handzel, Centers for Disease Control and Prevention
Purpose
This project aimed to determine the safety and acceptability of urine-diversion toilets in a refugee camp setting in Ethiopia. Urine-diversion toilets are potentially valuable for public health in environments where pit latrines are not possible. Although these latrines have been in use for many years in non-emergency settings, they have only been implemented on a small scale in humanitarian crises. This programme of applied research sought to determine if these designs can be effectively utilised at scale in humanitarian contexts. Research focused on the refugee population’s acceptance and effective use of the latrines, and the performance of the toilets under real climatic conditions to create a safe end product. The research outcomes will help implementing agencies determine whether urine-diversion toilets, as currently designed, are an appropriate intervention in this type of setting.
Programmes and Outcomes Achieved
Both qualitative surveys and laboratory-based research were successfully undertaken. Surveys were carried out across 400 households representing both users and non-users of UDDTs, approximately 18-months apart, to determine user attitudes and practices. For the environmental samples, 20 UDDTs were seeded with known quantities of parasitic worms, and samples collected and analysed at regular intervals over a 12-month storage period to evaluate the performance of the UDDTs in the refugee camp setting. Research on additive use was undertaken in controlled lab settings by adding several combinations of lime/ash to stored waste to enhance microbial inactivation. The evaluation provided valuable insight into the current acceptability and usability of the Urine Diverting Dry Toilets (UDDTs) in Hiloweyn camp, several years into the programme and after considerable scale-up.
Key findings:
It was found that generally adoption and current, consistent and correct use of the UDDTs was high among users in the Hiloweyn refugee camp setting.
A number of factors were found to be associated with satisfaction of the sanitation system. These included the type of sanitation system that the targeted user is familiar with; the cleanliness of the UDDT; and the length of time available for users to become accustomed to this new type of sanitation system.
Results from the lab tests indicated that storage of waste within UDDTs for 12-months is a conservative approach for treatment in this setting, where waste is not currently being used for agricultural purposes. With appropriate use of personal protective equipment and reasonable precautions at the secondary storage location, waste stored for 12-months in-vault could be moved for land application.
The addition of lime was found to increase the rate of microbial inactivation, suggesting that this may provide an additional level of microbiological safety for vault emptying as well as potentially allowing decreased storage time.
Key outputs:
Technical Report of findings published
Workshop in Ethiopia to share key findings with stakeholders (UNHCR, Oxfam and Norwegian Refugee Council)
2 peer reviewed publications anticipated, focusing on acceptability findings and laboratory performance results
Presentation of findings at Emergency Environmental Health Forum 2016 and UNC Water and Health 2017 conference
Poster presented at R2HC Research Forum 2017
Next steps:
Study findings have helped to inform additional pilots of UDDTs by Oxfam and UNHCR in other locations in Ethiopia.
Dr Thomas Handzel
(PI), CDC
“Sanitation doesn’t always get the attention, or funding, it deserves even though it is fundamental to public health. This has been a unique opportunity to study UDDT use over an extended period of time in a humanitarian setting where the provision of latrines is both difficult and expensive. UDDTs are a potential alternative to latrines and documenting their use and safety is essential.”
Laboratory and field partner collaborations in Ethiopia key to evaluation of performance of UDDTs
Aug 2016
We are studying the safety of these UDDTs in terms of their ability to facilitate microbial inactivation of stored feces. The principal design features of these UDDTs are an alternating,…
Mobile Data Collection Enables Completion of Baseline Acceptability Survey
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We started this project in July 2014. After significant project delays due to security concerns and access issues in Dollo Ado, we worked together with our local partners, United Nations…
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