Sanitation practices and perceptions in Kakuma refugee camp, Kenya: Comparing the status quo with a novel service-based approach

Abstract

Globally, an estimated 2.5 billion people lack access to improved sanitation. Unimproved sanitation increases the risk of morbidity and mortality, especially in protracted refugee situations where sanitation is based on pit latrine use. Once the pit is full, waste remains in the pit, necessitating the construction of a new latrine, straining available land and funding resources. A viable, sustainable solution is needed. This study used qualitative and quantitative methods to design, implement, and pilot a novel sanitation system in Kakuma refugee camp, Kenya. An initial round of 12 pre-implementation focus group discussions (FGDs) were conducted with Dinka and Somali residents to understand sanitation practices, perceptions, and needs. FGDs and a supplementary pre-implementation survey informed the development of an innovative sanitation management system that incorporated the provision of urine and liquid-diverting toilets, which separate urine and fecal waste, and a service-based sanitation system that included weekly waste collection. The new system was implemented on a pilot scale for 6 weeks. During the implementation, bi-weekly surveys were administered in each study household to monitor user perceptions and challenges. At the end of the pilot, the sanitation system was assessed using a second round of four post-implementation FGDs. Those who piloted the new sanitation system reported high levels of user satisfaction. Reported benefits included odor reduction, insect/pest reduction, the sitting design, the appropriateness for special populations, and waste collection. However, urine and liquid diversion presented a challenge for users who perform anal washing and for women who had experienced female genital mutilation. Refugee populations are often culturally and ethnically diverse. Using residents’ input to inform the development of sanitation solutions can increase user acceptability and provide opportunities to improve sanitation system designs based on specific needs.

A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health

“…Al-Delaimy et al, 2014 Interventions that focused on the construction of latrines and toilets were successful in reducing the incidence of diarrhea (Chaudhuri, 2017), improving overall health (Katsivo et al, 1993), and providing more women with the privacy and safety necessary to attend to their menstrual health needs (Chaudhuri, 2017). However, while generally well-tolerated (Nyoka et al, 2017;Yeasmin et al, 2017), latrines and waste bins are associated with challenges. For example, both men and women reported feelings of disgust with menstrual rags being placed in waste bins (Yeasmin et al, 2017).…”

“…For example, both men and women reported feelings of disgust with menstrual rags being placed in waste bins (Yeasmin et al, 2017). Furthermore, women affected by genital mutilations had issues using latrines (Nyoka et al, 2017). As well, culture played a role in women preferring to openly defecate instead of using latrines (Nyoka et al, 2017).…”

“…Furthermore, women affected by genital mutilations had issues using latrines (Nyoka et al, 2017). As well, culture played a role in women preferring to openly defecate instead of using latrines (Nyoka et al, 2017). Hygiene-related interventions were likewise successful at alleviating disease.…”

Taking Container-Based Sanitation to Scale: Opportunities and Challenges

“…The containers are regularly collected and transported to treatment facilities when full. Since 2010, modern CBS iterations have rapidly evolved into a viable, low-cost sanitation option, particularly in low-income urban settlements where demand for sanitation services is high and on-site sanitation and sewerage are not feasible or cost-effective (O'Keefe et al, 2015;Russel et al, 2015;Tilmans et al, 2015;Nyoka et al, 2017). While transporting waste in containers is not a new concept, doing so in a cost effective, safe and desirable manor has been a significant improvement over previous systems (Nilsson, 2006;Letema et al, 2014).…”

Exploring exposure risk and safe management of container-based sanitation systems: a case study from Kenya

“…importantly, cBs represents an entire value chain for faecal waste management that is independent of sewered infrastructure. Key sanitation service providers using cBs systems include sanivation, sOil, sanergy, and clean Team (Thomas et al, 2018;O'Keefe et al, 2015;nyoka et al, 2017).…”