Volume 98, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered “improved sanitation” because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one’s own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5–12 years and for disposal of feces of children < 5 years, compared with households using public latrines. However, within-compound access was not associated with improved child feces disposal by other caregivers in the compound. Feces was rarely observed in household compounds but was observed more often in compounds with latrines versus compounds relying on public latrines. and human adenovirus were detected frequently on household surfaces, but concentrations did not differ when compared by latrine access or usage practices. The differences in latrine use for households sharing within-compound versus public latrines in Accra suggest that disaggregated shared sanitation categories may be useful in monitoring global progress in sanitation coverage. However, compound access did not completely ensure that households were protected from feces and microbial contamination.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416. [Google Scholar]
  2. Liu L, 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161. [Google Scholar]
  3. Pruss-Ustun A, 2014. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 19: 894905. [Google Scholar]
  4. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt WP, , 2010. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 39 (Suppl 1): i193i205. [Google Scholar]
  5. Barreto ML, 2007. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet 370: 16221628. [Google Scholar]
  6. Haller L, Hutton G, Bartram J, , 2007. Estimating the costs and health benefits of water and sanitation improvements at global level. J Water Health 5: 467480. [Google Scholar]
  7. United Nations Development Programme, 2015. Introducing the 2030 Agenda for Sustainable Development. United Nations Development Programme New York, NY.
  8. World Health Organization and UNICEF, 2015. 25 Years Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment. New York, NY: World Health Organization and UNICEF. Available at: http://www.wssinfo.org/fileadmin/user_upload/resources/JMPreport2013.pdf. Accessed October 1, 2016.
  9. World Health Organization and UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2010. JMP Technical Task Force Meeting on Sanitation and Methods for Estimating Progress. New York, NY: World Health Organization and UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Available at: http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Sanitation-Method-Task-Force-Meeting-Report-July-2010-final.pdf. Accessed October 1, 2016.
  10. Baker KK, 2016. Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhea in young children in the global enteric multicenter study, 2007–2011: case-control study. PLoS Med 13: e1002010. [Google Scholar]
  11. Fuller JA, Clasen T, Heijnen M, Eisenberg JN, , 2014. Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001–2011. Am J Trop Med Hyg 91: 173180. [Google Scholar]
  12. Peprah D, Baker KK, Moe C, Robb K, Wellington N, Yakubu H, Null C, , 2015. Public toilets and their customers in low-income Accra, Ghana. Environ Urban 27: 589604. [Google Scholar]
  13. Biran A, Jenkins MW, Dabrase P, Bhagwat I, , 2011. Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India. Trop Med Int Health 16: 854862. [Google Scholar]
  14. Kwiringira J, Atekyereza P, Niwagaba C, Gunther I, , 2014. Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums. BMC Public Health 14: 624. [Google Scholar]
  15. Heijnen M, Routray P, Torondel B, Clasen T, , 2015. Neighbour-shared versus communal latrines in urban slums: a cross-sectional study in Orissa, India exploring household demographics, accessibility, privacy, use and cleanliness. Trans R Soc Trop Med Hyg 109: 690699. [Google Scholar]
  16. Kwiringira J, Atekyereza P, Niwagaba C, Kabumbuli R, Rwabukwali C, Kulabako R, Gunther I, , 2016. Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda. BMC Public Health 16: 361. [Google Scholar]
  17. Nelson KB, Karver J, Kullman C, Graham JP, , 2014. User perceptions of shared sanitation among rural households in Indonesia and Bangladesh. PLoS One 9: e103886. [Google Scholar]
  18. Biran A, Tabyshalieva A, Salmorbekova Z, , 2005. Formative research for hygiene promotion in Kyrgyzstan. Health Policy Plan 20: 213221. [Google Scholar]
  19. Kwiringira J, Atekyereza P, Niwagaba C, Gunther I, , 2014. Gender variations in access, choice to use and cleaning of shared latrines; experiences from Kampala Slums, Uganda. BMC Public Health 14: 1180. [Google Scholar]
  20. Gil A, Lanata CF, Kleinau E, Mary P, , 2004. Children’s Feces Disposal Practices in Developing Countries and Interventions to Prevent Diarrheal Diseases: A Literature Review. Strategic Report 11. Peru: Environmental Health Project (EHP). Washington, DC: United States Agency for International Development (USAID).
  21. Curtis V, Kanki B, Mertens T, Traore E, Diallo I, Tall F, Cousens S, , 1995. Potties, pits and pipes: explaining hygiene behaviour in Burkina Faso. Soc Sci Med 41: 383393. [Google Scholar]
  22. Aluko OO, Afolabi OT, Olaoye EA, Adebayo AD, Oyetola SO, Abegunde OO, , 2017. The management of the faeces passed by under five children: an exploratory, cross-sectional research in an urban community in southwest Nigeria. BMC Public Health 17: 178. [Google Scholar]
  23. Azage M, Haile D, , 2015. Factors associated with safe child feces disposal practices in Ethiopia: evidence from demographic and health survey. Arch Public Health 73: 40. [Google Scholar]
  24. Vujcic J, Ram PK, Hussain F, Unicomb L, Gope PS, Abedin J, Mahmud ZH, Islam MS, Luby SP, , 2014. Toys and toilets: cross-sectional study using children’s toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices. Trop Med Int Health 19: 528536. [Google Scholar]
  25. Weitzel T, Reither K, Mockenhaupt FP, Stark K, Ignatius R, Saad E, Seidu-Korkor A, Bienzle U, Schreier E, , 2007. Field evaluation of a rota- and adenovirus immunochromatographic assay using stool samples from children with acute diarrhea in Ghana. J Clin Microbiol 45: 26952697. [Google Scholar]
  26. Oshiro RK, , 2002. Membrane 1604: Total Coliforms and Escherichia coli in Water by Membrance Filtration Using a Simultaneous Detection Technique. Washington, DC: Environmental Protection Agency.
  27. Jothikumar N, Cromeans TL, Hill VR, Lu X, Sobsey MD, Erdman DD, , 2005. Quantitative real-time PCR assays for detection of human adenoviruses and identification of serotypes 40 and 41. Appl Environ Microbiol 71: 31313136. [Google Scholar]
  28. Majorin F, Freeman MC, Barnard S, Routray P, Boisson S, Clasen T, , 2014. Child feces disposal practices in rural Orissa: a cross sectional study. PLoS One 9: e89551. [Google Scholar]
  29. Pellow D, , 2008. Landlords and Lodgers: Socio-Spatial Organization in an Accra Community. Chicago, IL: University of Chicago Press.
  30. Merry SE, , 1987. Neighborhood and Community Environments: Crowding, Conflict, and Neighborhood Regulation, Vol. 9. New York: Springer, 35–68.
  31. Tumwebaze IK, Mosler HJ, , 2015. Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums. Soc Sci Med 147: 7279. [Google Scholar]
  32. Simiyu S, Swilling M, Cairncross S, Rheingans R, , 2017. Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya. BMC Public Health 17: 68. [Google Scholar]
  33. Pickering AJ, Julian TR, Marks SJ, Mattioli MC, Boehm AB, Schwab KJ, Davis J, , 2012. Fecal contamination and diarrheal pathogens on surfaces and in soils among Tanzanian households with and without improved sanitation. Environ Sci Technol 46: 57365743. [Google Scholar]
  34. Lamparelli CC, Pogreba-Brown K, Verhougstraete M, Sato MI, Bruni Ade C, Wade TJ, Eisenberg JN, , 2015. Are fecal indicator bacteria appropriate measures of recreational water risks in the tropics: a cohort study of beach goers in Brazil? Water Res 87: 5968. [Google Scholar]
  35. Stewart JR, 2008. The coastal environment and human health: microbial indicators, pathogens, sentinels and reservoirs. Environ Health 7 (Suppl 2): S3. [Google Scholar]
  36. Simpson D, Jacangelo J, Loughran P, McIlroy C, , 2003. Investigation of potential surrogate organisms and public health risk in UV irradiated secondary effluent. Water Sci Technol 47: 3743. [Google Scholar]
  37. Harwood VJ, Levine AD, Scott TM, Chivukula V, Lukasik J, Farrah SR, Rose JB, , 2005. Validity of the indicator organism paradigm for pathogen reduction in reclaimed water and public health protection. Appl Environ Microbiol 71: 31633170. [Google Scholar]
  38. Bonadonna L, Briancesco R, Ottaviani M, Veschetti E, , 2002. Occurrence of Cryptosporidium oocysts in sewage effluents and correlation with microbial, chemical and physical water variables. Environ Monit Assess 75: 241252. [Google Scholar]
  39. Williams AP, Avery LM, Killham K, Jones DL, , 2005. Persistence of Escherichia coli O157 on farm surfaces under different environmental conditions. J Appl Microbiol 98: 10751083. [Google Scholar]
  40. Jang J, Hur HG, Sadowsky MJ, Byappanahalli MN, Yan T, Ishii S, , 2017. Environmental Escherichia coli: ecology and public health implications–a review. J Appl Microbiol 123: 570581. [Google Scholar]
  41. Fuller JA, Villamor E, Cevallos W, Trostle J, Eisenberg JN, , 2016. I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador. Int J Epidemiol 45: 460469. [Google Scholar]

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Supplemental Table

  • Received : 17 Aug 2017
  • Accepted : 05 Jan 2018
  • Published online : 19 Mar 2018

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