Research to address the global sanitation crisis

A range of co-existing and integrated sanitation systems, from onsite to sewered and centralized to decentralized, is needed to improve sanitation access in rapidly expanding cities around the globe.

Sanitation could evolve beyond its traditional focus on public health and environmental protection to address broader challenges. A portfolio approach is proposed, integrating diverse systems at various scales to optimize benefits including economic value, resource efficiency, climate resilience and human dignity.

Water, sanitation, and health are inseparable — poor planning risks contaminating water sources and sowing the seeds of long-term health crises.

Recent learnings in non-sewered sanitation remain fragmented; this Review integrates findings into one consistent terminology to identify synergies in scientific findings and explore future potential application of new technologies.

Wastewater, especially from slaughterhouses, carries higher levels of antibiotic-resistant genes than natural water, with hosts including Escherichia, Desulfobacter, Citrobacter, and Pseudomonas_E, according to metagenomic analysis of water samples from China.

Decentralized source separation offers a cost-effective, resilient alternative to conventional methods, enhancing resource recovery and reducing environmental impacts.

This systematic re-review of water, sanitation and hygiene trials found that women play a critical but instrumentalized role in research and intervention activities. Research and interventions need to change to enable, and not hinder, gender equality.

China’s history of large-scale water, sanitation and clean energy investments offers promising insights into the development of new interventions to reduce linear growth faltering among children and adolescents.

This Review identifies factors that lead to ‘unsafely managed sanitation’ in the United States, the specific types of access, and obstacles to characterizing and addressing the problem.

Access to sanitation is a fundamental right that is still missing, especially in many parts of low-income countries. This Perspective focuses on the impact of unclean school latrines on child health.

Greenhouse-gas emissions from the sanitation-service chain in Kampala may represent more than half of the total city-level emissions according to a whole-system analysis.

SDG 6.3 targets to half the proportion of untreated wastewater discharged to the environment by 2030 will substantially improve water quality globally, but a high-resolution surface water quality model suggests key thresholds will still not be met in regions with limited existing wastewater treatment.

The toilet could evolve from an unassuming household plumbing fixture to a critical engineering node for onsite wastewater treatment and reuse.

Improving sanitation technology and service is imperative for everyone, in every country.

Jan Kloppenborg Møller & Goran Goranović and colleagues introduce a data-driven twin methodology which balances physical knowledge with uncertainty quantifications. The approach makes it suited to application of real world problems with inherent unknowns. They demonstrate its application in the modelling and control of membrane water ultrafiltration

Qasmieh et al. estimate SARS-CoV-2 prevalence and the frequency of related public health outcomes in New York City in April/May 2022, via a cross-sectional survey of 1030 adults. Their findings suggest SARS-CoV-2 prevalence during the BA.2/BA.2.12.1 surge in New York City may have been underestimated by routine surveillance.

Roederer et al. estimate uptake of COVID-19 vaccines amongst migrants, homeless and precariously housed people in two regions of France with cross-sectional survey data. They also report sociodemographic factors and reasons associated with (non-)vaccination.

Armstrong et al. describe how rates of obesity and hypertension differ across three sub-populations of Brazil, including two under-studied Indigenous groups. The more urbanized cultures experience more obesity and hypertension, suggesting urbanization impacts cardiovascular health.

Holm et al. present a SARS-CoV-2 surveillance model linking hospitalization, seroprevalence, and wastewater concentrations. They fit this model to epidemic data from Kentucky, USA, to generate counterfactual scenarios highlighting the plausible effects of vaccination and changes in dynamics due to emergence of new variants.