Exploring exposure risk and safe management of container-based sanitation systems: a case study from Kenya
Little has been studied about the potential risks and hazards arising from the use and operation of container-based sanitation (CBS) systems. Building on existing risk assessment frameworks, this case study aimed to identify exposure risks from faecal pathogens and relevant control measures in a CBS service chain. The case study employed a mixed-methods approach that included environmental sampling, key informant interviews, and direct observation. This inclusion of a behavioural dimension reflects a socio-cultural approach to risk analysis that is less evident in overtly quantitative approaches to risk assessment that are typical of the health risk field. Data from this case study was collected in Naivasha, Kenya in July 2016. The hazard intensity and role of specific transmission routes was validated by environmental sampling, which found a high level of faecal contamination on toilet surfaces and a consequent high risk of hand-to-mouth infection for users and operators. The hazard analysis identified nine critical control points where exposure risks may be either prevented or reduced via the implementation of relevant control measures. We discovered that the production of exposure risks was related to multiple, inter-related causal mechanisms and risk factors, findings we expect will guide approaches to exposure risk management in the future.