This practice paper concerns the management of occupational exposure risks during the operation of container-based sanitation (CBS) systems. The paper reports on findings based on three different CBS systems. An exposure risk assessment was conducted in each case study following a methodology adapted from the WHO Sanitation Safety Planning (SSP) Framework. The specific methods of data collection comprised a risk assessment workshop, as well as in-depth interviews and sanitary surveys to support and explain the findings from the risk assessment workshops. The analysis of the occupational exposure risks classified exposure risks into four categories of ‘drivers’ of exposure risk. These ‘drivers’ were supported by relevant secondary literature of exposure risk studies. The classification of hazardous events and exposure risks in CBS systems recognized: (1) the role of technical design and maintenance and condition of facilities, as well as manual aspects of labour; followed by (2) human behaviour; (3) system performance; and (4) physical environment. This classification is expected to simplify the exposure risk management process and provides a framework for the subsequent identification and management of occupational exposure in CBS systems. The framework is an additional tool within the sanitation safety planning toolkit to measure and manage exposure risks and thereby ensure safe sanitation performance. This research addresses a current knowledge gap in occupational exposure risks in CBS systems. The integration and use of these results in an adapted SSP framework may build a stronger business case for the adoption of CBS systems in city-wide urban sanitation sector planning.

Aroua, N. (2016) ‘Urban vulnerability and resiliency over water-related risks: a case study from Algiers’, Water Science and Technology 73(5): 1145–54 <http://dx.doi.org/10.2166/wst.2015.588>.

Avery, L.M., Booth, P., Campbell, C., Tompkins, D. and Hough, R.L. (2012) ‘Prevalence and survival of potential pathogens in source-segregated green waste compost’, Science of the Total Environment 431: 128–38 <http://dx.doi.org/10.1016/j.scitotenv.2012.05.020>.

Baxter, P. and Jack, S. (2008) ‘Qualitative case study methodology: study design and implementation for novice researchers’, The Qualitative Report 13(4): 544–59.

Bischel, H.N., Özel Duygan, B.D., Strande, L., McArdell, C.S., Udert, K.M. and Kohn, T. (2015) ‘Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa’, Water Research 85: 57–65 <http://dx.doi.org/10.1016/j.watres.2015.08.022>.

Bleck, D. and Wettberg, W. (2012) ‘Waste collection in developing countries: tackling occupational safety and health hazards at their source’, Waste Management 32(11): 2009–17 <http://dx.doi.org/10.1016/j.wasman.2012.03.025>.

Cairncross, S., Cumming, O., Jeandron, A., Rheingans, R., Ensink, J., Brown, J. and Cavill, S. (2013) DFID Evidence Paper: Water, Sanitation and Hygiene [online], DFID <http://r4d.dfid.gov.uk/Output/193434/Default.aspx> [accessed 11 April 2019].

Contzen, N. and Mosler, H. (no date) The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) Approach to Systematic Behavior Change [pdf], EAWAG Fact Sheet <https://www.eawag.ch/fileadmin/Domain1/Abteilungen/ess/schwerpunkte/ehpsy/RANAS_Methodological_Fact_Sheets.pdf> [accessed 10 June 2019].

Feacham, R., Bradley, D.J., Garelick, H. and Mara, D.D. (eds.) (1983) Sanitation and Disease: Health Aspects of Excreta and Wastewater Management, Washington, DC: World Bank.

Garenne, M. (2010) ‘Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa’, Archives of Disease in Childhood 95(6): 464–8.

Giusti, L. (2009) ‘A review of waste management practices and their impact on human health’, Waste Management 29(8): 2227–39 <http://dx.doi.org/10.1016/j.wasman.2009.03.028>.

Gretsch, S.R., Ampofo, J.A., Baker, K.K., Clennon, J., Null, C.A., Peprah, D. and Reese, H. (2016) ‘Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana’, Journal of Water and Health 14(2): 255–66.

Gwebu, T.D. (2003) ‘Population, development, and waste management in Botswana: conceptual and policy implications for climate change’, Environmental Management 31(3): 348–54.

Haagsma, J.a.,Tariq, L., Heederik, D.J. and Havelaar, A.H. (2012) ‘Infectious disease risks associated with occupational exposure: a systematic review of the literature’, Occupational and Environmental Medicine 69(2): 140–6 <http://dx.doi.org/10.1136/oemed-2011-100068>.

Höglund, C. (2001) ‘Evaluation of microbial health risks associated with the reuse of source-separated human urine’, PhD thesis, Royal Institute of Technology, Stockholm, Sweden.

HSE (1999) Reducing Error and Influencing Behaviour, Norwich: TSO.

Humphrey, J.H. (2009) ‘Child undernutrition, tropical enteropathy, toilets, and handwashing’, The Lancet 374(9694): 1032–5 <http://dx.doi.org/10.1016/S0140-6736(09)60950-8>.

Hurst, N.W. (1998) Risk Assessment The Human Dimensions, Letchworth, UK: Royal Society of Chemistry.

IWA (2016) Non-Sewered Sanitation Systems ISO/PC 305, London: IWA.

Kotloff, K.L., Nataro, J.P., Blackwelder, W.C., Nasrin, D., Farag, T.H., Panchalingam, S. and Wu, Y. (2013) ‘Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study’, The Lancet 382(9888): 209–22 <http://dx.doi.org/10.1016/S0140-6736(13)60844-2>.

Kwiringira, J., Atekyereza, P., Niwagaba, C., Kabumbuli, R., Rwabukwali, C., Kulabako, R. and Gunther, I. (2016) ‘Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda’, BMC Public Health 16: 361.

Leveson, N. (2012) ‘Safety-guided design’, in Engineering a Safer World: Systems Thinking Applied to Safety, Cambridge, MA: MIT Press.

Masibo, P.K. and Makoka, D. (2012) ‘Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008-2009’, Public Health Nutrition 15(9): 1715–27.

Mayer, J. (1986) ‘Ecological associative analysis’, in M. Pacione (ed.), Medical Geography: Progress and Prospect, p. 64, London: Croom Helm.

Michie, S., van Stralen, M.M. and West, R. (2011) ‘The behaviour change wheel: a new method for characterising and designing behaviour change interventions’, Implementation Science 6(1): 42 <http://dx.doi.org/10.1186/1748-5908-6-42>.

Mosler, H. (2012) ‘A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline’, International Journal of Environmental Health Research 3123 (August 2017) <http://dx.doi.org/10.1080/09603123.2011.650156>.

Pearson, C., Littlewood, E., Douglas, P., Robertson, S., Gant, T.W. and Hansell, A.L. (2015) ‘Exposures and health outcomes in relation to bioaerosol emissions from composting facilities: a systematic review of occupational and community studies’, Journal of Toxicology and Environmental Health. Part B, Critical Reviews 18(1): 43–69 <http://dx.doi.org/10.1080/10937404.2015.1009961>.

Rongo, L.M.B., Barten, F., Msamanga, G.I., Heedrerik, D. and Dolmans, W.M.V. (2004) ‘Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis’, Occupational Medicine 54(1): 42–46 <http://dx.doi.org/10.1093/occmed/kqh001>.

Russel, K., Tilmans, S., Kramer, S., Sklar, R., Tillias, D. and Davis, J. (2015) ‘User perceptions of and willingness to pay for household container-based sanitation services: experience from Cap Haitien, Haiti’, Environment and Urbanization 27(2): 525–40 <http://dx.doi.org/10.1177/0956247815596522>.

Schoenning, C. and Stenström, T.A. (2004) Guidelines for the Safe Use of Urine and Faeces in Ecological Sanitation Systems [pdf], EcoSanRes Report 2004-1, Stockholm: Stockholm Environment Institute <http://www.ecosanres.org/pdf_files/ESR_Publications_2004/ESR1web.pdf> [accessed 10 June 2019].

Stenström, T.A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems [pdf], Stockholm Environment Institute <www.ecosanres.org> [accessed 11 April 2019].

Swuste, P. and Eijkemans, G. (2002) ‘Occupational safety, health, and hygiene in the urban informal sector of sub-Saharan Africa: an application of the Prevention and Control Exchange (PACE) program to the informal-sector workers in Healthy City projects’, International Journal of Occupational and Environmental Health 8(2): 113–8 <http://dx.doi.org/10.1179/107735202800338920>.

Tilmans, S., Russel, K., Sklar, R., Page, L., Kramer, S. and Davis, J. (2016) ‘Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti’, Environment and Urbanization 27(6): 89–104 <http://dx.doi.org/10.1177/0956247815572746>.

Tregenza, T. (2009) Preventing Harm to Cleaning Workers [pdf], Bilbao, Spain: European Agency for Safety and Health at Work <https://osha.europa.eu/en/publications/reports/TEWE09006ENC/view> [accessed 10 June 2019].

WHO (2006) Third Edition of the WHO Guidelines for the Safe Use of Wastewater, Excreta and Greywater in Agriculture and Aquaculture Guidance Note for National Programme Managers and Engineers: Applying The Guidelines Along The Sanitation Ladder, Geneva: WHO.

WHO (2016) Sanitation Safety Planning [online], Geneva: WHO <https://www.who.int/water_sanitation_health/publications/ssp-manual/en/> [accessed 10 April 2019].

WHO (2017) Progress on Drinking Water, Sanitation and Hygiene, Joint Monitoring Programme, Geneva: World Health Organization.

Worku, Y. and Muchie, M. (2012) ‘An attempt at quantifying factors that affect efficiency in the management of solid waste produced by commercial businesses in the city of Tshwane, South Africa’, Journal of Environmental and Public Health 2012: 165353 <http://dx.doi.org/10.1155/2012/165353>.

Aroua, N. (2016) ‘Urban vulnerability and resiliency over water-related risks: a case study from Algiers’, Water Science and Technology 73(5): 1145–54 <http://dx.doi.org/10.2166/wst.2015.588>.

Avery, L.M., Booth, P., Campbell, C., Tompkins, D. and Hough, R.L. (2012) ‘Prevalence and survival of potential pathogens in source-segregated green waste compost’, Science of the Total Environment 431: 128–38 <http://dx.doi.org/10.1016/j.scitotenv.2012.05.020>.

Baxter, P. and Jack, S. (2008) ‘Qualitative case study methodology: study design and implementation for novice researchers’, The Qualitative Report 13(4): 544–59.

Bischel, H.N., Özel Duygan, B.D., Strande, L., McArdell, C.S., Udert, K.M. and Kohn, T. (2015) ‘Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa’, Water Research 85: 57–65 <http://dx.doi.org/10.1016/j.watres.2015.08.022>.

Bleck, D. and Wettberg, W. (2012) ‘Waste collection in developing countries: tackling occupational safety and health hazards at their source’, Waste Management 32(11): 2009–17 <http://dx.doi.org/10.1016/j.wasman.2012.03.025>.

Cairncross, S., Cumming, O., Jeandron, A., Rheingans, R., Ensink, J., Brown, J. and Cavill, S. (2013) DFID Evidence Paper: Water, Sanitation and Hygiene [online], DFID <http://r4d.dfid.gov.uk/Output/193434/Default.aspx> [accessed 11 April 2019].

Contzen, N. and Mosler, H. (no date) The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) Approach to Systematic Behavior Change [pdf], EAWAG Fact Sheet <https://www.eawag.ch/fileadmin/Domain1/Abteilungen/ess/schwerpunkte/ehpsy/RANAS_Methodological_Fact_Sheets.pdf> [accessed 10 June 2019].

Feacham, R., Bradley, D.J., Garelick, H. and Mara, D.D. (eds.) (1983) Sanitation and Disease: Health Aspects of Excreta and Wastewater Management, Washington, DC: World Bank.

Garenne, M. (2010) ‘Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa’, Archives of Disease in Childhood 95(6): 464–8.

Giusti, L. (2009) ‘A review of waste management practices and their impact on human health’, Waste Management 29(8): 2227–39 <http://dx.doi.org/10.1016/j.wasman.2009.03.028>.

Gretsch, S.R., Ampofo, J.A., Baker, K.K., Clennon, J., Null, C.A., Peprah, D. and Reese, H. (2016) ‘Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana’, Journal of Water and Health 14(2): 255–66.

Gwebu, T.D. (2003) ‘Population, development, and waste management in Botswana: conceptual and policy implications for climate change’, Environmental Management 31(3): 348–54.

Haagsma, J.a.,Tariq, L., Heederik, D.J. and Havelaar, A.H. (2012) ‘Infectious disease risks associated with occupational exposure: a systematic review of the literature’, Occupational and Environmental Medicine 69(2): 140–6 <http://dx.doi.org/10.1136/oemed-2011-100068>.

Höglund, C. (2001) ‘Evaluation of microbial health risks associated with the reuse of source-separated human urine’, PhD thesis, Royal Institute of Technology, Stockholm, Sweden.

HSE (1999) Reducing Error and Influencing Behaviour, Norwich: TSO.

Humphrey, J.H. (2009) ‘Child undernutrition, tropical enteropathy, toilets, and handwashing’, The Lancet 374(9694): 1032–5 <http://dx.doi.org/10.1016/S0140-6736(09)60950-8>.

Hurst, N.W. (1998) Risk Assessment The Human Dimensions, Letchworth, UK: Royal Society of Chemistry.

IWA (2016) Non-Sewered Sanitation Systems ISO/PC 305, London: IWA.

Kotloff, K.L., Nataro, J.P., Blackwelder, W.C., Nasrin, D., Farag, T.H., Panchalingam, S. and Wu, Y. (2013) ‘Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study’, The Lancet 382(9888): 209–22 <http://dx.doi.org/10.1016/S0140-6736(13)60844-2>.

Kwiringira, J., Atekyereza, P., Niwagaba, C., Kabumbuli, R., Rwabukwali, C., Kulabako, R. and Gunther, I. (2016) ‘Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda’, BMC Public Health 16: 361.

Leveson, N. (2012) ‘Safety-guided design’, in Engineering a Safer World: Systems Thinking Applied to Safety, Cambridge, MA: MIT Press.

Masibo, P.K. and Makoka, D. (2012) ‘Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008-2009’, Public Health Nutrition 15(9): 1715–27.

Mayer, J. (1986) ‘Ecological associative analysis’, in M. Pacione (ed.), Medical Geography: Progress and Prospect, p. 64, London: Croom Helm.

Michie, S., van Stralen, M.M. and West, R. (2011) ‘The behaviour change wheel: a new method for characterising and designing behaviour change interventions’, Implementation Science 6(1): 42 <http://dx.doi.org/10.1186/1748-5908-6-42>.

Mosler, H. (2012) ‘A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline’, International Journal of Environmental Health Research 3123 (August 2017) <http://dx.doi.org/10.1080/09603123.2011.650156>.

Pearson, C., Littlewood, E., Douglas, P., Robertson, S., Gant, T.W. and Hansell, A.L. (2015) ‘Exposures and health outcomes in relation to bioaerosol emissions from composting facilities: a systematic review of occupational and community studies’, Journal of Toxicology and Environmental Health. Part B, Critical Reviews 18(1): 43–69 <http://dx.doi.org/10.1080/10937404.2015.1009961>.

Rongo, L.M.B., Barten, F., Msamanga, G.I., Heedrerik, D. and Dolmans, W.M.V. (2004) ‘Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis’, Occupational Medicine 54(1): 42–46 <http://dx.doi.org/10.1093/occmed/kqh001>.

Russel, K., Tilmans, S., Kramer, S., Sklar, R., Tillias, D. and Davis, J. (2015) ‘User perceptions of and willingness to pay for household container-based sanitation services: experience from Cap Haitien, Haiti’, Environment and Urbanization 27(2): 525–40 <http://dx.doi.org/10.1177/0956247815596522>.

Schoenning, C. and Stenström, T.A. (2004) Guidelines for the Safe Use of Urine and Faeces in Ecological Sanitation Systems [pdf], EcoSanRes Report 2004-1, Stockholm: Stockholm Environment Institute <http://www.ecosanres.org/pdf_files/ESR_Publications_2004/ESR1web.pdf> [accessed 10 June 2019].

Stenström, T.A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems [pdf], Stockholm Environment Institute <www.ecosanres.org> [accessed 11 April 2019].

Swuste, P. and Eijkemans, G. (2002) ‘Occupational safety, health, and hygiene in the urban informal sector of sub-Saharan Africa: an application of the Prevention and Control Exchange (PACE) program to the informal-sector workers in Healthy City projects’, International Journal of Occupational and Environmental Health 8(2): 113–8 <http://dx.doi.org/10.1179/107735202800338920>.

Tilmans, S., Russel, K., Sklar, R., Page, L., Kramer, S. and Davis, J. (2016) ‘Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti’, Environment and Urbanization 27(6): 89–104 <http://dx.doi.org/10.1177/0956247815572746>.

Tregenza, T. (2009) Preventing Harm to Cleaning Workers [pdf], Bilbao, Spain: European Agency for Safety and Health at Work <https://osha.europa.eu/en/publications/reports/TEWE09006ENC/view> [accessed 10 June 2019].

WHO (2006) Third Edition of the WHO Guidelines for the Safe Use of Wastewater, Excreta and Greywater in Agriculture and Aquaculture Guidance Note for National Programme Managers and Engineers: Applying The Guidelines Along The Sanitation Ladder, Geneva: WHO.

WHO (2016) Sanitation Safety Planning [online], Geneva: WHO <https://www.who.int/water_sanitation_health/publications/ssp-manual/en/> [accessed 10 April 2019].

WHO (2017) Progress on Drinking Water, Sanitation and Hygiene, Joint Monitoring Programme, Geneva: World Health Organization.

Worku, Y. and Muchie, M. (2012) ‘An attempt at quantifying factors that affect efficiency in the management of solid waste produced by commercial businesses in the city of Tshwane, South Africa’, Journal of Environmental and Public Health 2012: 165353 <http://dx.doi.org/10.1155/2012/165353>.

Aroua, N. (2016) ‘Urban vulnerability and resiliency over water-related risks: a case study from Algiers’, Water Science and Technology 73(5): 1145–54 <http://dx.doi.org/10.2166/wst.2015.588>.

Avery, L.M., Booth, P., Campbell, C., Tompkins, D. and Hough, R.L. (2012) ‘Prevalence and survival of potential pathogens in source-segregated green waste compost’, Science of the Total Environment 431: 128–38 <http://dx.doi.org/10.1016/j.scitotenv.2012.05.020>.

Baxter, P. and Jack, S. (2008) ‘Qualitative case study methodology: study design and implementation for novice researchers’, The Qualitative Report 13(4): 544–59.

Bischel, H.N., Özel Duygan, B.D., Strande, L., McArdell, C.S., Udert, K.M. and Kohn, T. (2015) ‘Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa’, Water Research 85: 57–65 <http://dx.doi.org/10.1016/j.watres.2015.08.022>.

Bleck, D. and Wettberg, W. (2012) ‘Waste collection in developing countries: tackling occupational safety and health hazards at their source’, Waste Management 32(11): 2009–17 <http://dx.doi.org/10.1016/j.wasman.2012.03.025>.

Cairncross, S., Cumming, O., Jeandron, A., Rheingans, R., Ensink, J., Brown, J. and Cavill, S. (2013) DFID Evidence Paper: Water, Sanitation and Hygiene [online], DFID <http://r4d.dfid.gov.uk/Output/193434/Default.aspx> [accessed 11 April 2019].

Contzen, N. and Mosler, H. (no date) The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) Approach to Systematic Behavior Change [pdf], EAWAG Fact Sheet <https://www.eawag.ch/fileadmin/Domain1/Abteilungen/ess/schwerpunkte/ehpsy/RANAS_Methodological_Fact_Sheets.pdf> [accessed 10 June 2019].

Feacham, R., Bradley, D.J., Garelick, H. and Mara, D.D. (eds.) (1983) Sanitation and Disease: Health Aspects of Excreta and Wastewater Management, Washington, DC: World Bank.

Garenne, M. (2010) ‘Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa’, Archives of Disease in Childhood 95(6): 464–8.

Giusti, L. (2009) ‘A review of waste management practices and their impact on human health’, Waste Management 29(8): 2227–39 <http://dx.doi.org/10.1016/j.wasman.2009.03.028>.

Gretsch, S.R., Ampofo, J.A., Baker, K.K., Clennon, J., Null, C.A., Peprah, D. and Reese, H. (2016) ‘Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana’, Journal of Water and Health 14(2): 255–66.

Gwebu, T.D. (2003) ‘Population, development, and waste management in Botswana: conceptual and policy implications for climate change’, Environmental Management 31(3): 348–54.

Haagsma, J.a.,Tariq, L., Heederik, D.J. and Havelaar, A.H. (2012) ‘Infectious disease risks associated with occupational exposure: a systematic review of the literature’, Occupational and Environmental Medicine 69(2): 140–6 <http://dx.doi.org/10.1136/oemed-2011-100068>.

Höglund, C. (2001) ‘Evaluation of microbial health risks associated with the reuse of source-separated human urine’, PhD thesis, Royal Institute of Technology, Stockholm, Sweden.

HSE (1999) Reducing Error and Influencing Behaviour, Norwich: TSO.

Humphrey, J.H. (2009) ‘Child undernutrition, tropical enteropathy, toilets, and handwashing’, The Lancet 374(9694): 1032–5 <http://dx.doi.org/10.1016/S0140-6736(09)60950-8>.

Hurst, N.W. (1998) Risk Assessment The Human Dimensions, Letchworth, UK: Royal Society of Chemistry.

IWA (2016) Non-Sewered Sanitation Systems ISO/PC 305, London: IWA.

Kotloff, K.L., Nataro, J.P., Blackwelder, W.C., Nasrin, D., Farag, T.H., Panchalingam, S. and Wu, Y. (2013) ‘Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study’, The Lancet 382(9888): 209–22 <http://dx.doi.org/10.1016/S0140-6736(13)60844-2>.

Kwiringira, J., Atekyereza, P., Niwagaba, C., Kabumbuli, R., Rwabukwali, C., Kulabako, R. and Gunther, I. (2016) ‘Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda’, BMC Public Health 16: 361.

Leveson, N. (2012) ‘Safety-guided design’, in Engineering a Safer World: Systems Thinking Applied to Safety, Cambridge, MA: MIT Press.

Masibo, P.K. and Makoka, D. (2012) ‘Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008-2009’, Public Health Nutrition 15(9): 1715–27.

Mayer, J. (1986) ‘Ecological associative analysis’, in M. Pacione (ed.), Medical Geography: Progress and Prospect, p. 64, London: Croom Helm.

Michie, S., van Stralen, M.M. and West, R. (2011) ‘The behaviour change wheel: a new method for characterising and designing behaviour change interventions’, Implementation Science 6(1): 42 <http://dx.doi.org/10.1186/1748-5908-6-42>.

Mosler, H. (2012) ‘A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline’, International Journal of Environmental Health Research 3123 (August 2017) <http://dx.doi.org/10.1080/09603123.2011.650156>.

Pearson, C., Littlewood, E., Douglas, P., Robertson, S., Gant, T.W. and Hansell, A.L. (2015) ‘Exposures and health outcomes in relation to bioaerosol emissions from composting facilities: a systematic review of occupational and community studies’, Journal of Toxicology and Environmental Health. Part B, Critical Reviews 18(1): 43–69 <http://dx.doi.org/10.1080/10937404.2015.1009961>.

Rongo, L.M.B., Barten, F., Msamanga, G.I., Heedrerik, D. and Dolmans, W.M.V. (2004) ‘Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis’, Occupational Medicine 54(1): 42–46 <http://dx.doi.org/10.1093/occmed/kqh001>.

Russel, K., Tilmans, S., Kramer, S., Sklar, R., Tillias, D. and Davis, J. (2015) ‘User perceptions of and willingness to pay for household container-based sanitation services: experience from Cap Haitien, Haiti’, Environment and Urbanization 27(2): 525–40 <http://dx.doi.org/10.1177/0956247815596522>.

Schoenning, C. and Stenström, T.A. (2004) Guidelines for the Safe Use of Urine and Faeces in Ecological Sanitation Systems [pdf], EcoSanRes Report 2004-1, Stockholm: Stockholm Environment Institute <http://www.ecosanres.org/pdf_files/ESR_Publications_2004/ESR1web.pdf> [accessed 10 June 2019].

Stenström, T.A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems [pdf], Stockholm Environment Institute <www.ecosanres.org> [accessed 11 April 2019].

Swuste, P. and Eijkemans, G. (2002) ‘Occupational safety, health, and hygiene in the urban informal sector of sub-Saharan Africa: an application of the Prevention and Control Exchange (PACE) program to the informal-sector workers in Healthy City projects’, International Journal of Occupational and Environmental Health 8(2): 113–8 <http://dx.doi.org/10.1179/107735202800338920>.

Tilmans, S., Russel, K., Sklar, R., Page, L., Kramer, S. and Davis, J. (2016) ‘Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti’, Environment and Urbanization 27(6): 89–104 <http://dx.doi.org/10.1177/0956247815572746>.

Tregenza, T. (2009) Preventing Harm to Cleaning Workers [pdf], Bilbao, Spain: European Agency for Safety and Health at Work <https://osha.europa.eu/en/publications/reports/TEWE09006ENC/view> [accessed 10 June 2019].

WHO (2006) Third Edition of the WHO Guidelines for the Safe Use of Wastewater, Excreta and Greywater in Agriculture and Aquaculture Guidance Note for National Programme Managers and Engineers: Applying The Guidelines Along The Sanitation Ladder, Geneva: WHO.

WHO (2016) Sanitation Safety Planning [online], Geneva: WHO <https://www.who.int/water_sanitation_health/publications/ssp-manual/en/> [accessed 10 April 2019].

WHO (2017) Progress on Drinking Water, Sanitation and Hygiene, Joint Monitoring Programme, Geneva: World Health Organization.

Worku, Y. and Muchie, M. (2012) ‘An attempt at quantifying factors that affect efficiency in the management of solid waste produced by commercial businesses in the city of Tshwane, South Africa’, Journal of Environmental and Public Health 2012: 165353 <http://dx.doi.org/10.1155/2012/165353>.

Aroua, N. (2016) ‘Urban vulnerability and resiliency over water-related risks: a case study from Algiers’, Water Science and Technology 73(5): 1145–54 <http://dx.doi.org/10.2166/wst.2015.588>.

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