September 18, 2024

— Story by Gillings School Assistant Professor Musa Manga

Dr. Musa Manga

Dr. Musa Manga

Dr. Jill Stewart

Dr. Jill Stewart

Researchers from the Department of Environmental Sciences and Engineering (ESE) at the UNC-Chapel Hill Gillings School of Global Public Health spent the summer working with communities in Kampala, Uganda, and Lusaka, Zambia, monitoring how sanitation system failures influence the movement of disease-causing organisms through urban environments.

Researchers Musa Manga, PhD, and Jill Stewart, PhD, both on the ESE faculty, are working with communities in Kampala and Lusaka to understand how different sanitation technologies — including sewers, septic tanks and pit latrines — contribute to fecal pathogen hazards within communities. Fecal pathogens are microorganisms that spread from the feces of one person to the mouth of another, causing disease; they include the bacteria, viruses and parasites responsible for diseases such as cholera, norovirus and giardia, among others.

ESE researchers Dr. Musa Manga and doctoral student Lauren Sprouse stand with the University of Zambia field team.

ESE researchers Dr. Musa Manga and doctoral student Lauren Sprouse stand with the University of Zambia field team.

The latest water, sanitation and hygiene (WASH)-related burden of disease estimates suggest that 1.4 million people die each year due to inadequate WASH conditions, most of which occur in low- and middle-income countries. The project that Manga and Stewart lead as co-principal instigators, which is funded by the Bill & Melinda Gates Foundation, aims to improve sanitation conditions in low-income urban areas by helping sanitation planners and engineers set priorities for sanitation interventions and investments to maximize public health benefits. The ultimate goal is to reduce unsafe returns of human waste — and associated pathogens — to the environment.

The project is a collaboration among several institutions, including Kampala Capital City Authority (KCCA), the Ugandan Ministry of Water and Environment, Makerere University, Lusaka Water Supply and Sanitation (LWSC), the University of Zambia, and other local government entities in Uganda and Zambia.

Spillage during transport of fecal sludge to treatment facilities can lead to contamination within and around communities.

Spillage during transport of fecal sludge to treatment facilities can lead to contamination within and around communities.

The study is designed around the sanitation service chain: the series of actions and actors that control the containment, transport, treatment and disposal of human waste. Weaknesses in one link of the chain can affect the performance — and, ultimately, the public health impact — of the entire sanitation system. By measuring pathogen hazards in overflows and spillages along the chain, researchers can identify areas of weakness and locations at risk of sanitation-related diseases.

Another key goal of the project is to build research capacity among African country partners. Strengthening collaborations, fostering mentorship and engaging in bidirectional learning are at the heart of the project.

“Working with the field teams always involves two-way training,” said Lauren Sprouse, MPH, a d0ctoral student in Manga’s lab. “While we trained them on environmental sample collection and lab analysis methods, we learned just as much, if not more, about their communities, cultural practices, preferences and priorities.”

The UNC-Chapel Hill team, led by Dr. Musa Manga, trained field workers on collecting samples from various sanitation technologies.

The UNC-Chapel Hill team, led by Dr. Musa Manga, trained field workers on collecting samples from various sanitation technologies.

The team will continue collecting data over the next year, using results to develop a Community Pathogen Hazard Flow model to track how pathogens move through urban environments based on the type of sanitation technologies encountered in communities, sanitation user practices, climate change and more. By engaging with stakeholders and reporting back results, they will explore how local government officials and sanitation engineers can apply identify and prioritize sanitation interventions in Sub-Saharan African communities from the public health perspective.

“Our project is a great example of Gillings’ commitment to local-to-global research and practice,” said Manga. “We hope that our findings will help to not only improve sanitation conditions in our specific study communities, but also help with setting sanitation priorities around the world.”

Doctoral students Lauren Sprouse (left) and Sarah Lebu tour the Bugoloobi Wastewater Treatment Plant in Kampala, Uganda, which is the largest wastewater treatment facility in East Africa.

Doctoral students Lauren Sprouse (left) and Sarah Lebu tour the Bugoloobi Wastewater Treatment Plant in Kampala, Uganda, which is the largest wastewater treatment facility in East Africa.

Currently, public health workers and engineers have no clear way to assess the relative public health significance of different sanitation problems, scenarios, or interventions. The team hopes for their CHF model to improve the understanding of environmental health consequences of both existing and proposed sanitation improvements, allowing for better prioritizing and design of sanitation interventions and promoting public health.


Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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