Estimating the Health Risk Associated with the Use of Ecological Sanitation Toilets in Malawi

Abstract

Use of Ecological Sanitation (EcoSan) sludge is becoming popular due to increasing price of organic fertilizers in Malawi; however, there is little evidence on the associated risks. Quantitative microbiological risk assessment (QMRA) was done to determine health risks associated with use of EcoSan. Pathogens considered includedEscherichia coli (E. coli),Salmonella,and soil transmitted helminths (STHs). Exponential and Beta Poisson models were used to estimate the risk from helminthic and bacterial pathogens, respectively. Main exposure pathways were through poor storage of sludge, contamination of foods during drying, walking barefoot on the ground contaminated with sludge, pit emptying without protection, and application of sludge in the fields. Estimated annual risk forAscaris lumbricoides, Taenia, andhookworms was approximately over 5.6 × 10−1for both Fossa Alternas (FAs) and Urine Diverting Dry Toilet (UDDTs). Risk fromE. coliandSalmonellawas 8.9 × 10−2and above. The risks were higher than WHO acceptable risk for use of faecal sludge in crops of 10−4infections per year. Promoters and users of EcoSan latrines need to consider advocating for strict guidelines to reduce the risk.