Thanks for the questions on my work. First on whether the results have led to change in policy by the local authority. I would like to say that the area of safety of EcoSan humus was identified as a priority area by the Malawi Government and when we started the research we sent proposals, preliminary results and final results to the responsible ministries. These were Ministry of Agriculture, Irrigation and Water Development and Ministry of Health. They wanted to use the results to come up with a stand on whether to join NGOs in promoting EcoSan latrines or not. The Ministries after receiving the results have not made any decision on the same. Currently, we are planning to summarize the results so that they can easily be used by policy makers. We are delayed because we want to extend the study to look at why the hookworm eggs still persisted in the sludge despite the resistant ones being killed. We think it was due to high environmental contamination. Once this is done, we will have complete information to present to the ministries.

We do not have research results on what happens after 2 years of storage. We only stopped observing after one year and during that time Ascaris lumbricoides eggs were reduced to less that one per gram which is less than the WHO recommendation for use of sludge in agriculture. However, hookworm eggs which were expected to be eliminated easily were found in concentrations of more than five per gram. This is why we planning for further research.

We do not have evidence that shows the relationship between use of EcoSan humus and health status, however, in one of our papers we have just shown that humus from users of EcoSan has more Ascaris lumbricoides eggs than other types of helminths eggs. This shows that because Ascaris lumbricoides survives in humus and because of handling during use, the users of these latrines are more likely to be infected by Ascaris lumbricoides.

Thanks


-- Save Kumwenda
Department of Environmental Health University of Malawi, The Polytechnic Private Bag 303 Chichiri, Blantyre 3

Thanks for adding the three papers to this thread, Joe.
Interesting research indeed!

I'd like to know from Save if the research results have led (or are likely to lead in the near future) to a change in policy or in recommendations by local authorities?

You said storage for longer than one year is recommended but do you have any research results that show was happens after e.g. 2 years of storage?

Is there any evidence on how this affects the health of the users, i.e. do you think, suspect or know that people who use those kinds of toilets (you called them EcoSan systems) are more likely to be of poor health? I doubt that would be the case because from your earlier response it seems that reuse activities are not taking place. If there is no reuse then the users don't come into significant contact with the stored materials from the vaults or do they?

Regards,
Elisabeth

Sorry to post a third time but there is another paper published very recently

Inactivation of pathogens in ecological sanitation latrines
in Malawi: An observational follow up study by Save Kumwenda, Chisomo Msefula, Wilfred Kadewa, Davis James Makupe, Bagrey Ngwira, Tracy Morse

Link here (note you have to download a PDF of the paper there unlike the other two papers

"Despite showing a reduction in mean concentration of hookworm eggs per gram of sludge, the number of latrines with the helminths in their sludge increased. This might be
due to high prevalence of hookworms in the population and the poor practices of households members in terms of management of stored sludge leading to contamination.
A. lumbricoides showed a decrease in both number of viable eggs per gram and number of EcoSan latrines with
the helminth during the follow-up period. In terms of helminths, it was only the hookworm that was above the recommended guidelines for use of excreta. A. lumbricoidesdespite being an indicator organism, was unable to predict the concentration of hookworm which is less resistant to
environmental conditions than A. lumbricoides. The absence of A. lumbricoides meant that other less resistant helminths were also supposed to be inactivated before A. lumbricoides but this was not the case. This could be because of the high levels of environmental contamination due to poor hygiene
practices."

I'd like to thank Save and team for these fascinating results.

Next paper:

Title: Is there a difference in prevalence of helminths between households using ecological sanitation and those using traditional pit latrines? A latrine based cross sectional comparative study in Malawi by Save Kumwenda, Chisomo Msefula, Wilfred Kadewa, Yohane Diness, Charles Kato, Tracy Morse and Bagrey Ngwira

Link here

Conclusion:

"There was no significant difference between overall prevalence of helminths between households using EcoSan and those using traditional pit latrines. However, Ascaris lumbricoides was significantly higher in households using EcoSan latrines. EcoSan users need awareness on safe ways of handling faecal sludge in order to reduce chances of reinfection from Ascaris lumbricoides."

I don't know if this is the best place to put the following, but Save Kumwenda had two other interesting papers from the work described above.

One appears to be an open access paper, title "Estimating the Health Risk Associated with the Use of Ecological Sanitation Toilets in Malawi" by Save Kumwenda, Chisomo Msefula, Wilfred Kadewa, Bagrey Ngwira, and Tracy Morse

Link here

As mentioned above, they are dual vault alternating latrines (with and without UD) which users add soil and ash to after use and which are normally emptied after six months.

After being sealed for 12 months, Helminth levels were still high for both types and the QMRA suggested that

"The risk of 5.6× 10−1 means that about 6 out of 10 (60%) people using FAs or UDDTs will be infected by A. lumbricoides during a year or at an individual level; it means that out of ten exposures to sludge 6 times will result in infection. The risk obtained was above the WHO recommendation of between
10−4 and 10−3 infections per year"

Thanks Elisabeth, this work is part of my PhD at University of Malawi under Consortium for Advanced Research Training for Africa (CARTA) fellowship. Its currently completed but will be continued through my postgraduate funding. The background to this research is based on another study under SHARE which found that most of faecal sludge from EcoSan latrines sampled across Malawi had high levels of helminths despite some of them following the recommended guideline of 6months waiting period. My study was them aimed at discovering some practices that may lead to pathogen survival. It also compared the helminthic load in fossa alterna and UDDTs (Paperpunder review) and the research will also assess the health risk to users of such toilets.

The Study also followed up 55 EcoSan toilets for a period of 12 months. During this time of follow up, faecal samples were periodically analysed and temperature, humidity, moisture content, pH and ammonia were also monitored to understand the factors that contribute significantly to pathogen die off. This paper will soon be submitted for publication.

Next research is aimed at checking environmental contamination of helminths around households and fields where EcoSan sludge was used

I will share more soon..

Thanks

Thanks Chris,
The paper is available online on the following website: washdev.iwaponline.com/content/early/201.../20/washdev.2016.177. The users have theoretical understanding of how the toilets work but their knowledge is not directly translated into the right practices because of several challenges including weather changes and lack of resources. The users preference of the system depended on location, those in peri urban areas preferred the urine diverting dry toilet because it looks a bit improved than the fossa alterna while those in rural areas could not afford the urine diverting dry toilet and they preferred the skyloo. But regardless of costs, all users preferred the urine diverting dry toilet.

In terms of use of faecal sludge, there was very low use in peri urban areas, most people just remove it and dispose the manure in the rubbish pits because they do not have gardens and have nowhere to sale. Others do not use for agriculture because they feel disgusted with the sludge/faeces. The usage was a bit higher in rural areas because households find artificial fertilizer as expensive but still a good number were still not using the faecal sludge. The important benefit that they treasure were saving space because it can be reused over and over again and that it does not collapse during rainy season for the case of fossa alterna common in rural areas. The urine was not used and was directed to a soakaway pit in all the toilets. People do not have adequate knowledge and skills to use urine.

Arborloos have been promoted but due to the added work of shifting the superstructure, they have been abandoned and are now almost non existence. We expected to find them but we didnt find any. It would have been really good to compare.

Thanks

The paper that Save has posted above appeared here:
washdev.iwaponline.com/content/6/4/555?etoc

It's in the IWA Journal of Water Sanitation and Hygiene for Development.

Unfortunately it is behind a paywall; I presume the costs for making it open access were prohibitive for the authors.

Nevertheless I had encouraged Save Kumwenda to post about his paper here and am glad that Chris has already responded with some questions.

Save: could you please tell us a bit more about this work, e.g. by attaching a powerpoint presentation you might have done about this work, or by copying the main conclusions from the paper to here?

I see that you're from the University of Malawi. Could you tell us more about your current work, too? Are you continuing research about UDDTs in Malawi?

Regards,
Elisabeth

Dear Skumwenda,

Welcome to the Forum and thanks for this information.

Is the entire paper available on the internet? It good to know that almost all of the users understand these systems. Were the users happy with these toilets? Which system did they like best? What experience had there been in the use of urine and decomposed feces in agriculture? Have ArborLoos been applied there very much. If so, it would be good to include them in the comparison.

Please tell us more about you and your work.

Best wishes,
Chris Canaday

New paper:
Knowledge, attitudes and practices on use of Fossa Alternas and double vault urine diverting dry (DVUDD) latrines in Malawi

Save Kumwenda, Chisomo Msefula, Wilfred Kadewa, Bagrey Ngwira, Tracy Morse, Jeroen H. J. Ensink
Published December 2016, 6 (4) 555-568; DOI: 10.2166/washdev.2016.177

++++++++++++

ABSTRACT
Fossa alternas and double vault urine diverting dry(DVUDD)latrines have been extensively promoted as ecological sanitation (EcoSan) latrine options in Malawi, but little is known about whether they are used properly. A qualitative study of EcoSan users was conducted in Blantyre and Chikwawa districts, Malawi. Data were collected using in-depth interviews (IDIs). Twenty-eight (28) and seventeen (17) IDIs were conducted with household heads that had Fossa Alternas and DVUDD latrines, respectively. Recorded data were transcribed verbatim and analysed thematically. Of the total 45 EcoSan users, 40 had moderate to high knowledge on EcoSan latrine use, four had low knowledge and only one had no knowledge of how EcoSan latrines operate. Blockages of urine diversion systems,intensive management and maintenance needed for the latrines were reported as some problems related to the negative attitudes about EcoSan use. Use of soil and ash, urine diverting, use of hot water and chemicals to kill maggots, urinating in the drop-hole of the DVUDDs and poor maintenance of the roof were some of the practices reported on use of these latrines. It is therefore recommended that government, through community workers, should be monitoring practices on EcoSan latrine use and provide necessary support to users.

The paper has uncovered some important challenges on EcoSan use which boarder on inadequate skills and lack of resources.