A Review of User Vulnerabilities Associated with Shared Sanitation Practices in Sub-Saharan Africa

Abstract

Aims: Shared sanitation was excluded from the basic service level due to perceived limitations of their hygiene, accessibility and safety. But how does the current body of scientific knowledge influence the narrative? This paper is aimed at reviewing data on the current status and vulnerability issues reported to be associated with shared sanitation in Sub-Saharan Africa (SSA).
 Methodology: Literature was searched using key search terms from nine databases. Peer-reviewed articles and various reports of individual country studies published in English from January 2000 to April 2022 were selected.
 Results: As at 2020, the proportion of the population sharing sanitation facilities in SSA was estimated as 19% compared to 7% globally. The review revealed a mixed opinion about issues and vulnerabilities associated with shared sanitation which may have arisen from inconsistencies in the typologies and levels of sharing of facilities among the reviewed studies. Using shared sanitation was found to be associated with an increased risk of diarrheal diseases (OR=1.06; 95%CI: 1.03-1.08) and non-partner violence against women (OR=1.52; 95%CI: 1.22-1.82). However, there is also evidence that many shared facilities, particularly those shared by a few (2-3) households, are clean, meet the needs of the users and afford them similar health outcomes as non-shared facilities.
 Conclusion: The findings of the review suggest that the outright exclusion of all forms of shared sanitation from basic sanitation potentially underestimates the global efforts and progress toward access to sanitation. There is a need to segregate communal and public toilets from privately shared facilities in future research as well as the progress reporting by the Joint Monitoring Programme (JMP). It is also recommended that steps are taken by the JMP to develop indicators for identifying and incorporating quality shared sanitation facilities into the basic sanitation service level in order to give a more realistic account of the global effort towards sanitation access.

Usage and Microbial Safety of Shared and Unshared Excreta Disposal Facilities in Developing Countries: The Case of a Ghanaian Rural District

“…In Ghana and Kenya, Antwi-Agyei et al [39] found no statistically significant association between a toilet's cleanliness and the number of households sharing it, even though clean toilets were used by relatively fewer households than dirty toilets. Many of the studies that associate unclean toilets with sharing have been driven by communal and public toilets and not necessarily the household-level sharing of toilets [11].…”

“…Montgomery et al [10] found no difference in the risk of trachoma between households using shared or private toilets in rural Tanzania. In Mozambique, The Gambia, Rwanda, Senegal, and South Africa, the use of shared sanitation showed a protective effect against diarrhoea [11]. Evidence from Dar es Salaam, Tanzania, shows that shared toilets were positively associated with hygienically safe and functionally sustainable toilets [12].…”

“…Other reviews reported mixed findings. For instance, Obeng et al [11] reviewed the literature on the vulnerabilities associated with the use of shared toilets in sub-Saharan Africa and concluded that there seems to be a varied opinion among experts on issues regarding the sharing of sanitation facilities. While the study found sharing sanitation to be a risk factor for non-partner violence against women and diarrhoeal diseases, it also found evidence that many shared facilities, particularly those shared by two or three households, are clean and afford the users similar health outcomes to non-shared facilities.…”