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

Abstract

Sharing facilities with other households offers the most realistic opportunity for access to sanitation for many households in low-income settings. However, questions remain about the safety of shared toilets, including those shared at the household level. This study sought to compare the usage and microbial safety of household-level shared and unshared toilets in a Ghanaian rural district to investigate any association between their microbial safety and sharing status. A semi-structured questionnaire was used to collect data on the user characteristics of the sampled toilets, while common contact surfaces (door handles and toilet seats) were assessed for faecal contamination following standard swab sampling and analytical protocols. The results of the study indicate that sharing toilets affords about 90% more household-level access to sanitation as compared to single-household toilets. Toilet sharing mostly occurred between two households, with a maximum user population of 14 per toilet. Generally, there was a high prevalence of faecal contamination on the door handles and seats of both shared and unshared toilets, but this had no association with the sharing status of the toilets. The median concentration of Escherichia coli (E. coli) on the door handles and seats of shared toilets was 34.3 × 105 and 103.2 × 105 CFU/mL, respectively, as compared to 54.7 × 105 and 125.0 × 105 CFU/mL, respectively, on unshared toilets. In conclusion, the sharing of toilets at the household level nearly doubles access to sanitation at home without necessarily exposing the users to a higher risk of faecal–oral disease transmission.