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Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya

Author

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  • Kate Bohnert

    (Department of Environmental Health, Emory University, Atlanta, GA 30322, USA
    These authors contributed equally to this work.)

  • Anna N. Chard

    (Department of Environmental Health, Emory University, Atlanta, GA 30322, USA
    These authors contributed equally to this work.)

  • Alex Mwaki

    (Cooperative for Assistance and Relief Everywhere (CARE) Kenya, Muchai Road, P.O. Box 43864, Nairobi 00100, Kenya)

  • Amy E. Kirby

    (Hubert Department of Global Health, Emory University, Atlanta, GA 30322, USA)

  • Richard Muga

    (Department of Health Sciences, Great Lakes University of Kisumu, P.O. Box 2224, Kisumu 40100, Kenya)

  • Corey L. Nagel

    (School of Public Health, Oregon Health and Science University, Portland State University, Portland, OR 97239, USA)

  • Evan A. Thomas

    (College of Engineering and Computer Science, Portland State University, Portland, OR 97201, USA)

  • Matthew C. Freeman

    (Department of Environmental Health, Emory University, Atlanta, GA 30322, USA)

Abstract

The provision of safely managed sanitation in informal settlements is a challenge, especially in schools that require durable, clean, sex-segregated facilities for a large number of children. In informal settlements in Nairobi, school sanitation facilities demand considerable capital costs, yet are prone to breakage and often unhygienic. The private sector may be able to provide quality facilities and services to schools at lower costs as an alternative to the sanitation that is traditionally provided by the government. We conducted a randomized trial comparing private sector service delivery (PSSD) of urine-diverting dry latrines with routine waste collection and maintenance and government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. The primary outcomes were facility maintenance, use, exposure to fecal contamination, and cost. Schools were followed for one school year. There were few differences in maintenance and pathogen exposure between PSSD and GSD toilets. Use of the PSSD toilets was 128% higher than GSD toilets, as measured with electronic motion detectors. The initial cost of private sector service delivery was USD 2053 (KES 210,000) per school, which was lower than the average cost of rehabilitating the government standard flush-type toilets (USD 9306 (KES 922,638)) and constructing new facilities (USD 114,889 (KES 1,169,668)). The private sector delivery of dry sanitation provided a feasible alternative to the delivery of sewage sanitation in Nairobi informal settlements and might elsewhere in sub-Saharan Africa.

Suggested Citation

  • Kate Bohnert & Anna N. Chard & Alex Mwaki & Amy E. Kirby & Richard Muga & Corey L. Nagel & Evan A. Thomas & Matthew C. Freeman, 2016. "Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya," IJERPH, MDPI, vol. 13(12), pages 1-14, November.
    • Handle: RePEc:gam:jijerp:v:13:y:2016:i:12:p:1189-:d:84130
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    References listed on IDEAS

    as
    1. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273.
    2. Dreibelbis, R. & Freeman, M.C. & Greene, L.E. & Saboori, S. & Rheingans, R., 2014. "The impact of school water, sanitation, and hygiene interventions on the health of younger siblings of pupils: A cluster-randomized trial in Kenya," American Journal of Public Health, American Public Health Association, vol. 104(1), pages 91-97.
    3. Aime Tsinda & Pamela Abbott & Steve Pedley & Katrina Charles & Jane Adogo & Kenan Okurut & Jonathan Chenoweth, 2013. "Challenges to Achieving Sustainable Sanitation in Informal Settlements of Kigali, Rwanda," IJERPH, MDPI, vol. 10(12), pages 1-16, December.
    4. Kelly T. Alexander & Alex Mwaki & Dorothy Adhiambo & Malaika Cheney-Coker & Richard Muga & Matthew C. Freeman, 2016. "The Life-Cycle Costs of School Water, Sanitation and Hygiene Access in Kenyan Primary Schools," IJERPH, MDPI, vol. 13(7), pages 1-12, June.
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    Cited by:

    1. Jedidiah S. Snyder & Graeme Prentice-Mott & Charles Boera & Alex Mwaki & Kelly T. Alexander & Matthew C. Freeman, 2020. "The Sustainability and Scalability of Private Sector Sanitation Delivery in Urban Informal Settlement Schools: A Mixed Methods Follow Up of a Randomized Trial in Nairobi, Kenya," IJERPH, MDPI, vol. 17(15), pages 1-17, July.

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