Universal access to improved sanitation by 2030 with an emphasis on the rights of all excluded groups is one of the Sustainable Development Goals (SDGs). This chapter argues that Community-Led Total Sanitation (CLTS) can support the achievement of this goal. However open defecation free (ODF) status can be put at risk by just one person. It will be unachievable and unsustainable unless people who are marginalized and vulnerable are actively and meaningfully included, consulted, and considered in all aspects of CLTS programming. Without this, there is a risk of inappropriate design or location of facilities, overlooking the needs of people who are marginalized, which can limit or deny their access to sanitation. This chapter outlines the dimensions of equality and non-discrimination and barriers to access, and suggests practical entry points for inclusive and sustainable CLTS programming.

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The possible occurrence of metabolic acidosis in patients with intestinal ileus is not well recognized. We describe a patient with acute alcohol-induced pancreatitis and a large transverse colon ileus in which plasma bicarbonate dropped rapidly in the absence of an increase in the plasma anion gap. The urinary anion gap and ammonium excretion were consistent with an appropriate renal response to metabolic acidosis and against the possibility of respiratory alkalosis. The cause of the falling plasma bicarbonate was ascribed to intestinal bicarbonate sequestration owing to the enhancement of chloride-bicarbonate exchange in a dilated paralyzed colon.