Poor management of fecal sludge (FSM) presents significant risks to public health and the environment. This study employed qualitative and quantitative data collection methods, along with the Shit Flow Diagram (SFD) data analyzing tool to investigate FSM patterns in Kombolcha town, Ethiopia. The findings indicate that 75.7% of housing unites in the town are shared toilets, with multiple households sharing a single facility. The primary toilet technologies used include cistern flush toilets (2.1%), pour/manual flush toilets (19.8%), ventilated improved pit latrines (11.1%), pit latrines with slabs (56.4%), and pit latrines without slabs (10.6%). However, 98.5% of these toilet types had either unlined or only partially lined containments. Furthermore, only 37% of households practice safe pit or sludge tank emptying. As a result, only 17% of fecal sludge goes through the sanitation value chain and is effectively treated, while 39% remains onsite and unemptied, and the remaining 44% is disposed of in a manner that poses risks to the environment and public health. The study highlights the significant public health and environmental risks associated with the high reliance on shared toilets, the prevalence of inadequately lined toilet types, and the low adoption of proper fecal sludge management practices. Addressing these challenges requires the implementation of sanitation bylaws and building code regulations that prioritize hygienic standards and promote improved toilet technologies.

Access to sanitation has become an important element for improving the health of populations in developing countries. In Burkina Faso, 12% of the population in rural areas has access to latrine and 65% practice open defecation (OD). In a bid to eliminate this unsanitary practice and enhance sanitation access in rural areas, the government embraced community-led total sanitation (CLTS) as a national strategy in 2014. However, more than 6 years later, a notable observation is the high abandonment rate, with only a small fraction of rural communities successfully eradicating OD. Out of the 8892 villages in the country, 3546 underwent a CLTS triggering from 2014 to 2020. Nevertheless, in 787 of these villages, the implementation of the CLTS approach was abandoned, indicating a substantial abandonment rate of 22.19%. Until now, most studies on CLTS have focused on the post-ODF phase, emphasizing the question of the sustainability of the results generated by the approach, as if the process from triggering to obtaining ODF certification was not subject to any problems. However, cases of abandonment of the CLTS process after triggering do exist, although poorly documented in the literature, and there are no studies that clearly assign responsibilities to the actors when CLTS implementation comes to be abandoned. This research aims to bridge these gaps by identifying the root causes of these abandonment cases while delineating the distinct responsibilities associated with these instances. To achieve this, the study was conducted in the Central-Western region of Burkina Faso, where all stakeholders involved in CLTS implementation, including target communities, were identified, their different roles in the process defined, and data collected through household surveys, interviews, and focus groups. The content analysis method was used to analyze the data. The research findings indicate that the abandonment of the CLTS implementation process is due to four categories of factors: sociocultural and economic aspects (39.78%), physical conditions (17.52%), governance aspects (26.28%), and the quality of approach implementation (16.42%). Moreover, these factors highlight a shared accountability for abandonment involving the government, implementing organizations, and target communities. These findings have significant implications for the future design of sanitation programs using the CLTS approach. To mitigate abandonment rates in the CLTS implementation process across rural communities, it is imperative for policymakers to attentively consider these factors and integrate the recommendations delineated in this study.

Despite the Philippines\' progress in gender equality, contemporary evidence suggests that Filipinos continue to possess negative attitudes toward lesbian and gay individuals. Likewise, discrimination and violence toward bisexual, transgender, and queer Filipinos have been documented. Despite cases of sexual orientation and gender identity and expression (SOGIE) based discrimination, national-level anti-discrimination legislation remains unpassed in the Senate. This study explores the national discussions on the SOGIE Equality Bill triggered by a bathroom discrimination experienced by a Filipino transgender woman in 2019. Taking cues from Richardson\'s sexual citizenship framework, we investigate the diverse rights discourses among sectoral groups, such as local lesbian, gay, bisexual, transgender, queer, and other individuals of marginalized sexualities and genders (LGBTQ+) organizations and their allies, high-ranking Filipino politicians, and religious organizations. Analysis of local discourses showed that those supporting the SOGIE Equality Bill leverage identity-based rights discourses, while those opposed primarily navigate these debates using conduct-based rights discourses. Future policy and advocacy work must leverage the insights from these public proceedings to foster LGBTQ + solidarity in their campaigns for LGBTQ + rights in the country. Particularly, future work must (1) locate the middle ground between the LGBTQ + community and opposed legislators; (2) highlight essential values and common issues shared by all Filipinos; (3) surface how privilege can preclude and advance solidarity within the LGBTQ + community; (4) campaign for the passage of local anti-discrimination ordinances; (5) improve the SOGIE-related competencies of policy implementers; and (6) engage in research that explores public discourses and meanings assigned to sexual rights among Filipinos.

Selecting an appropriate sanitation option involves multiple stakeholders with often conflicting objectives. A multiple criteria decision analysis (MCDA) framework was developed to inform decision makers on selecting appropriate sanitation options for rural communities. Criteria established from literature were evaluated and weighted on-line by stakeholders. A performance matrix was developed by assigning weights to criteria and scoring alternatives. Selection of alternatives was based on a composite appropriateness index from a rank using the simple multi-attribute ranking technique. The framework was evaluated by verification, validation and sensitivity analysis. Five alternatives were evaluated on 14 decision criteria. The first preferred alternative was the urine diverting dry toilet (72.54) then the Blair ventilated improved pit latrine (67.10). The framework was commented as reasonable and robust. A simple and transparent MCDA framework was developed considering local conditions in a participatory manner to select appropriate alternatives for rural sanitation where a single option is encouraged.

Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco\'s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California.
We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions at 27 locations across 10 San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms.
Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). In the same restrooms, the rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change = -0.024 [95% CI = -0.033, -0.014]). In a subset of restrooms, where new installations were made (Mission and Golden Gate Park), and in another subset of restrooms where restroom attendants were provided (Mission, Castro/Upper Market, and Financial District/South Beach), feces reports also declined.
Increased access to public toilets reduced feces reports in San Francisco, especially in neighborhoods with people experiencing homelessness. The addition of restroom attendants also appeared to have reduced feces reports in some neighborhoods with PEH. These interventions should be audited for implementation quality, observed utilization data, and user experience at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.

Home adaptation can be a key contributor to successfully aging at home, allowing older adults to remain in a familiar environment while maintaining their quality of life and well-being despite progressing functional difficulties. Although several theoretical studies on home adaptations exist, the benefits of custom home adaptations remain poorly evaluated. The present study\'s primary aims were to explore older adults\' expectations and needs regarding home adaptations and evaluate the impact of individualized home adaptations on quality of life, fear of falling, independence, and difficulties using adapted rooms. Its secondary aim was to describe the barriers and facilitators of home adaptation.
The 15 homes in this case series were adapted using an inclusive, interdisciplinary approach. Adaptations\' effects were assessed using a parallel mixed-methods design. Quantitative and qualitative data were collected using questionnaires and semi-structured interviews. An architect and a health professional visited each home twice to assess the older adult\'s expectations and needs, evaluate the home\'s technical aspects, and co-create an adaptation plan with that study participant. They assessed the older adult\'s perceived quality of life, fear of falling, independence, and difficulties using the rooms needing adaptations. Inhabitants received two more visits after the adaptations (one or two months and six months later) to assess their benefits.
Most homes had their bathroom adapted. Participants reported improved safety, independence, ease of use, positive feelings, and comfort. They also reported lower perceived levels of difficulties during the activities of daily living in the adapted rooms (reductions of 93.4% [SD = 12.7] of bathrooms and 100% of kitchens), an improvement in quality of life of 9.8% (SD = 27.6), and a reduction in fear of falling of 12.5% (SD = 9.7).
Home adaptations are beneficial to older adults\' activities of daily living and improve their quality of life; however, several factors hinder the implementation of those adaptations.

The Swachh Bharat Mission undertaken by the Government of India (GoI) has been successful in accomplishing this objective within a short period thereby catalyzing governance following Sustainable Development Goals (SDGs). It is the responsibility of any democratic nation to ensure that its citizens have universal access to adequate and equitable sanitation. The key approach adapted to igniting a change in sanitation behavior rather than constructing toilets. An effort has been made in the study to affirm that even the marginalized sections of the society residing in tribal communities of West Bengal and Chhattisgarh have benefitted from this Government of India Mission and derived the required benefits. There is enough literature available to support the justification that civil participation holds the key for successful implementation of CLTS thereby making the communities open defecation free (ODF). It is therefore imperative to understand the behavioral transformation that takes place during the CLTS implementation. A hybrid model has been proposed in the study making use of the theory of reasoned action (TRA) and theory of planned behavior (TPB) to understand the pre-adoption and post-adoption behavior of residents. In present study, used model was empirically tested for several hypotheses. The finding reflects towards subjective norms and facilitating conditions as major determinants that ensure the continuation of intention for CLTS. They play a pivotal role in improving the health and hygiene conditions in the region and thus decrease the risk of spread of epidemic diseases.

Public toilets are essential infrastructure to guarantee the right to sanitation in public spaces and, in more general terms, the right to inclusive and sustainable cities. Moreover, since the equipment has a direct user interface, it is important to understand their demands and needs. Given this, the present research aims to understand the perspective of public toilet users on the Pampulha Lake Shore (PLS), a public touristic place in Belo Horizonte, Brazil. For that, observations and semi-structured interviews were carried out with different public toilet users. In addition, comments posted on the Google Local Guides tool of Google Maps were used as a secondary database for understanding users\' experience of PLS toilets. The analysis made it possible to identify aspects related to availability, quality (health and hygiene), security, and accessibility. Collected data showed how the conflicting choice of whether or not to use the toilet was directly related to the health and conservation of the urban equipment and interfered with social and leisure prospects. On the whole, the importance of the user\'s perspective was highlighted in this study with emphasis on elaborating adequate urban planning with regard to health, sanitation, and accessibility issues.

Introduction: In order to meet the sustainable development goals targets of sanitation, countries aim to increase access to safely managed sanitation services for its citizens. Safely managed sanitation services refers to improved sanitation technologies that are not shared with other households and where excreta is treated and disposed; or stored, transported and treated off-site. In most Sub-Saharan Africa (SSA) countries, on-site sanitation facilities such as latrines and septic tanks are common, with low-income urban settlements mainly using pit latrines. However, little is documented about the management of sludge from these facilities, especially in low income settlements in secondary and emerging cities. This lack of data is a major hindrance to public health, development and planning efforts by governments and planning agencies. This study specifically assesses practices and challenges along the sanitation value chain related to containment, emptying, transportation, treatment and recycling of fecal sludge. Methods: The study was carried out in low income settlements in Nakuru, a secondary city in Kenya. Over half the population in Nakuru live in low income areas and majority of these residents use pit latrines. A case study design was selected for this study and data was collected using qualitative methods. Data was collected through In-depth interviews and Focus Group Discussions using in depth interview guide and focus group discussion guides that had questions on sanitation practices along the value chain, challenges, opportunities available, and recommendations for improvement. Analysis was done through content analysis by reading the transcripts multiple times to gain a sense of the flow of the discussion. Thereafter, coding was done by following emergent issues and thereafter categories were identified which formed the basis for providing a picture of FWM practices in the settlements. Results: On site sanitation facilities are dominant in the settlements, but they are few and are shared by several households. These facilities were unclean, and they filled up at a fast rate because of the high number of users. The latrines were emptied by manual emptiers who used mechanized equipment but complemented with manual emptying using buckets. Sludge was transported to a central collection point using large and small scale means of transportation, before transfer to the treatment site for final treatment and disposal. Various stakeholders are involved in capacity building of emptiers as well as in the transportation, treatment and disposal of fecal sludge in the settlements. Challenges along the stages of the value chain included negative community perceptions and attitudes toward fecal sludge management. Conclusion: The results highlight the need to address the challenges along the chain by involvement of state and non-state actors. Low income areas have high populations and thus contribute huge amounts of fecal sludge. Deliberate efforts to consolidate such data from low income areas will result in availability of data, and informed decision making for stakeholders at national and international levels.

Open defecation practice problem is rampant in most rural areas of developing countries, including Ethiopia. To combat this problem, the Ethiopian government implemented different sanitation interventions including Community-Led Total Sanitation and Hygiene (CLTSH). The CLTSH approach is mainly aimed to eradicate open defecation practice through mobilizing the community to construct a latrine facility and utilize it. Although this intervention has significantly improved households\' access to a latrine facility, its impact on bringing behavioral change such as avoiding open defecation is not well studied.
Our study aimed to assess the prevalence of open defecation among households having their latrine and its determinant factors in rural settings in Northwest Ethiopia.
A community-based cross-sectional study was conducted in Machakal district from September 1 to 30, 2019. A total of 472 household heads who had a latrine facility and systematically selected from six rural Kebeles of the district, were involved in the study. The data were collected using a structured questionnaire and observational checklist tools through face-to-face interviews and observation methods. Bivariate and multivariable logistic regression models were run to identify the factors that influence open defecation practice. During the multivariable analysis, statistical significance was declared at the p-value of <0.05 with 95% CI.
The prevalence of open defecation practice among household heads who had latrine facility was 27.8% (95% CI, [23.1-32.8]). Female gender (AOR = 2.94, 95% CI [1.13-7.68]), not attending of formal education (AOR = 3.10, CI 95% [1.34-7.13]), having >5 family members (AOR = 1.72, CI 95% [1.05-2.80]), presence of under-five child (AOR = 3.64 CI 95% [2.14-6.21]), preferring leaf as anal cleaning material (AOR = 3.18, CI 95% [1.67-6.08]), having unclean latrine (AOR = 2.15, CI 95% [1.34-3.44]), and having latrine that needs maintenance (AOR = 2.50 CI 95% [1.52-4.11]) variables were associated with open defecation practice.
Among the total respondents, finding more than a quarter of open defecators is concerning for a district that achieved greatly in terms of latrine coverage. This indicates the above-mentioned factors contributed to influence household heads to defecate openly despite having latrines. Therefore, the government and partners need to focus on designing strategies that effectively address determinant factors of open defecation.