Institute for Sustainable Futures, University of Technology Sydney, Level 10, UTS Building 10, 235 Jones Street, Ultimo, NSW 2007, Australia.
Water & Health Pty Ltd., P.O. Box 648, Salamander Bay, NSW 2317, Australia.
Int J Environ Res Public Health. 2018 Jan 23;15(2):181. doi: 10.3390/ijerph15020181.
Public health benefits are often a key political driver of urban sanitation investment in developing countries, however, pathogen flows are rarely taken systematically into account in sanitation investment choices. While several tools and approaches on sanitation and health risks have recently been developed, this research identified gaps in their ability to predict faecal pathogen flows, to relate exposure risks to the existing sanitation services, and to compare expected impacts of improvements. This paper outlines a conceptual approach that links faecal waste discharge patterns with potential pathogen exposure pathways to quantitatively compare urban sanitation improvement options. An illustrative application of the approach is presented, using a spreadsheet-based model to compare the relative effect on disability-adjusted life years of six sanitation improvement options for a hypothetical urban situation. The approach includes consideration of the persistence or removal of different pathogen classes in different environments; recognition of multiple interconnected sludge and effluent pathways, and of multiple potential sites for exposure; and use of quantitative microbial risk assessment to support prediction of relative health risks for each option. This research provides a step forward in applying current knowledge to better consider public health, alongside environmental and other objectives, in urban sanitation decision making. Further empirical research in specific locations is now required to refine the approach and address data gaps.
公共卫生效益通常是发展中国家城市卫生投资的一个关键政治驱动因素，然而，病原体流动在卫生投资决策中很少被系统考虑。虽然最近已经开发了几种关于卫生和健康风险的工具和方法，但这些方法在预测粪便病原体流动、将暴露风险与现有的卫生服务联系起来以及比较改进的预期影响方面存在能力差距。本文概述了一种将粪便废物排放模式与潜在病原体暴露途径联系起来的概念方法，以定量比较城市卫生改善方案。本文介绍了该方法的一个实例应用，使用基于电子表格的模型比较了六种卫生改善方案对假设城市情况的残疾调整生命年的相对影响。该方法包括考虑不同环境中不同病原体类别的持久性或去除性；认识到多个相互关联的污泥和废水途径，以及多个潜在的暴露点；并利用定量微生物风险评估来支持对每种方案的相对健康风险的预测。这项研究在将现有知识应用于城市卫生决策中更好地考虑公共卫生以及环境和其他目标方面向前迈进了一步。现在需要在特定地点进行进一步的实证研究来完善该方法并解决数据差距。
