Solutions for effective and sustainable faecal sludge management (FSM) present a significant

global need. FSM is a relatively new eld, however, it is currently rapidly developing and gaining
acknowledgement. This essay provides an introduction to what FSM is, some of the unique
challenges of FSM, public health problems and environmental problems associated with poor
faecal sludge management and practical solutions to solve the problem.

Faecal sludge (FS) comes from onsite sanitation technologies, and has not been transported
through a sewer. It is raw or partially digested, a slurry or semisolid, and results from the
collection, storage or treatment of combinations of excreta and black water, with or without grey
water. Examples of onsite technologies include pit latrines, unsewered public ablution blocks,
septic tanks, aqua privies, and dry toilets. FSM includes the storage, collection, transport,
treatment and safe endues or disposal of FS. FS is highly variable in consistency, quantity, and
concentration.

Untreated sewage sludge is capable of harbouring sometimes high levels of a wide range of
bacteria (including drug-resistant forms), viruses and parasites and while differing forms of
sewage treatment reduces levels of each of these, the effect is of varying degree depending on
factors such as initial concentrations and resistance of the organism to treatment.Chief amongst
these organisms, with respect to risk to humans, are Salmonella spp, E. coli, Campylobacter,
Giardia and Ascaris. Hepatitis viruses can be found in sewage as do a range of other viruses if
looked for, and it is likely that intensive searching for specific organism may often result in
positive finds even if at low levels which may not be important in terms of risk to health.

Sewage sludge is a significant source of cadmium and lead and to a lesser extent mercury and
arsenic. Many chemicals, including a wide range of pharmaceutical agents, can be found in
sewage at variable concentrations. Treatment of sewage can result in dilution or concentration of
these substances depending on their chemical interactions and properties. It is difficult to
identify a best treatment which would reduce chemical content across the board.

Human excreta and the lack of adequate personal and domestic hygiene have been implicated in
the transmission of many infectious diseases including cholera, typhoid, hepatitis, polio,
cryptosporidiosis, ascariasis, and schistosomiasis. The World Health Organization (WHO)
estimates that 2.2 million people die annually from diarrhoeal diseases and that 10% of the

1
population of the developing world are severely infected with intestinal worms related to
improper waste and excreta management (Murray and Lopez 1996; WHO 2000a). Human
excreta-transmitted diseases predominantly affect children and the poor. Most of the deaths due
to diarrhoea occur in children and in developing countries (WHO 1999).

Faecally contaminated water, both marine and fresh, is a frequent cause of food-borne illness.
For example, some shellfish (such as mussels, oysters, and clams) obtain their food by filtering
large quantities of water and are therefore particularly likely to accumulate contamination.
Excreta-related human pathogens, heavy metals and other chemical contaminants are taken in
with the food particles and can be concentrated in the tissues. Shellfish are also frequently eaten
raw or partially cooked. Fish, and non-filter feeding shellfish (crabs, lobsters, prawns, shrimps)
grown in faecally contaminated water containing high levels of human pathogens can also
concentrate pathogens in their intestinal tracts and on their skin surfaces. When concentrations of
faecally derived bacteria exceed a certain level they can be found in muscle tissues (WHO 1989).
Infection may occur when the contaminated fish is consumed raw or lightly cooked. Food
handlers may also be at risk during preparation of the contaminated product.

When untreated or inadequately treated wastewater or excreta (faecal sludge) is applied to soil
and crops, disease transmission can occur. The persons at risk are the farmers, farm workers and
their families as well as consumers of crops.While radioactivity can be detected in sewage sludge
(from a range of sources including medical treatment and from industrial sources) levels are
likely to be low although no repeated data on content in sewage sludge could be identified in the
time available for this project.

Treatment processes reduce the level of pathogenic micro-organisms (including drug-resistant

strains) and PAHs in sewage sludge only partially, and the pathogenic organisms that survive
treatment are often of human origin. However, natural attenuation in soil of organisms from
applied sewage sludge can occur although to a variable extent where different factors (e.g. site)
will affect persistence. Clear identification of surviving organisms derived from non-human
animals has not been clearly defined.

Wastewater management is a human requirement whose main purpose is to separate human

waste from human settlements in order to prevent diseases (Flores et al., 2008). Wastewater is

2
water that has been used and may carry substances such as human waste, food scraps, oils, soaps
and chemicals. Wastewater is derived from residential, commercial and industrial activities. In
wastewater management, one of the big challenges is that of building new toilets and wastewater
collection systems (Frhacker, 2009).

For those people with income levels so low that they can hardly provide enough food for
themselves, poverty prevents them from investing in their sanitary facilities. Most cities face
numerous challenges with respect to water and sanitation services. Some of the challenges
include those of complying with wastewater standards, the reliability of power supply,
management of ageing infrastructure, extending infrastructure to meet developmental needs,
ensuring financial sustainability, and building human capacity capable of addressing these
pressing challenges (Carden et al., 2009).

Water and sanitation are essential to life, health, livelihood and dignity. They are regarded as
basic human rights (IWSD, 2012). The Universal Declaration of Human Rights, 1948, Article 25
(UN, 1949) states that: everyone has the right to a standard of living adequate for the health and
wellbeing of himself and his family. The timely and adequate provision of clean water and
sanitation to communities is of special importance given that people have traditionally faced
difficulties in fully exercising their rights and are very prone to exploitation (Shrestha and
Cronin, 2006).

Developing solutions for FSM is a serious global problem that has received limited attention
over the past twenty years (Strauss and Heinss, 1996). Compared to wastewater management
practice, there is a hundred year gap in knowledge of FSM in urban areas. However, the FSM eld
is now rapidly developing and gaining acknowledgement, as shown by many recent examples
where municipalities are adopting FSM into their urban planning (e.g. Dakar, Senegal and
Ouagadougou, Burkina Faso), and the commitment of organisations like the Bill & Melinda
Gates Foundation placing signicant resources into research of FSM. Recently, experience
through pilot and full-scale systems has started becoming available (Figure 1.4), but practice is
still not up to desired speeds. As awareness of the need for FSM has increased, so has the need
for solutions. However, information on FSM is generally not readily available and therefore the
objective of this book is to present an approach for the comprehensive and integrated
management of FS in urban and peri-urban areas of low- and middle-income countries.
3
When designing treatment technologies, the disposal option of sludge and liquid streams should
be determined, so that obtaining the appropriate level of treatment for the desired end use can be
incorporated into the design. Once the anal end use or disposal options have been selected, it
becomes possible to work backwards starting from the nal treatment requirements to design a
system that achieves the treatment objectives. For example, pathogen reduction and level of
sludge dryness requirements will be very different if the intended end product is compost for use
on food crops or if it is fuel for use as combustion in industrial processes. These decisions are
context specific, and need to be made based on local regulations and the market demand for end
products. Similar to designations for Class A and Class B bios lids in the United States, FS is
treated for levels of pathogen reduction that make it appropriate for different end uses. This
approach is important to ensure that effluents and end products achieve adequate and appropriate
levels of treatment; systems are not over-designed, wasting financial resources; and that systems
are not under-designed risking public and environmental health. Resource recovery from
treatment products should be considered as a treatment goal whenever possible, but the number
one goal is obviously the protection of public health.

In many low- and middle-income countries, regulations for the end use of sludge do not exist
and/or are not enforced. In the apparent lack of a regulatory environment, the required levels of
treatment become a societal decision. On the other hand, standards that are too strict may also
have a negative impact if they prevent action from being taken because they cannot be met. To
ensure adequate protection of human health, a multi-barrier approach is recommended, as they
offset sludge disposal costs, potentially provide a revenue stream, help to ensure treatment plants
are operated well to provide quality products, and provide a benefit to society through resource
recovery. This type of context-specific solution needs to take into account the local market
demand, and ways to increase the value of treatment products as markets vary significantly
among locations (Diener et al., 2014).

Proper excreta disposal and minimum levels of personal and domestic hygiene are essential for
protecting public health. Safe excreta disposal and handling act as the primary barrier for
preventing excreted pathogens from entering the environment. Once pathogens have been
introduced into the environment they can be transmitted via either the mouth (e.g. through
drinking contaminated water or eating contaminated vegetables/food) or the skin (as in the case

4
of the hookworms and schistosomes), although in many cases adequate personal and domestic
hygiene can reduce such transmission. Excreta and wastewater generally contain high
concentrations of excreted pathogens, especially in countries where diarrhoeal diseases and
intestinal parasites are particularly prevalent. Therefore for maximum health protection, it is
important to treat and contain human excreta as close to the source as possible before it gets
introduced into the environment.

For sustainable implementation and ongoing operation, FSM requires an integrated systems
approach incorporating technology, management and planning, as depicted in Figure 1.5. In this
book, chapters fall under each of the technology, management or planning sections, as is clearly
presented throughout the book by the colour scheme, but what is of utmost importance is how all
three of these fields come together to provide a framework that will guide practitioners from the
initial project planning phase to implementation and ongoing operations and maintenance phases.

A multi-disciplinary, systems-level approach to FSM like that developed here is required to

ensure that untreated FS is removed from the community, not remaining at the household level,
and that it is treated in a safe and effective manner. For example, removing sludge from the
household is a private interest, but the FSM service chain is a public interest, requiring regulation
and enforcement by an authority that is responsible for the public good. If only a few people in a
community properly manage FS, it would not have a net impact on the community as a whole;
there needs to be collective participation at the community scale to ensure that public health
benefits are realized. This requires sustained public sector commitment, effective policies,
appropriate implementation and enforcement to promote understanding and adherence (Klingel
et al., 2002), topics that are covered in the Planning and Management sections.

Conclusion

Poor sanitation practices lead to disease transmission through numerous pathways. To manage
the risks of excreta-related disease transmission, it is important to apply a multiple barrier
approach (similar to the hazard assessment and critical control point (HACCP) type program.
The use of safe sanitary installations and the appropriate handling, treatment and use of excreta
are important barriers or critical control points in the transmission of faecal-oral disease.
5
Effective excreta management programmes will reduce disease transmission via drinking water,
contact with recreational water and via the food chain. As discussed earlier, when such
management fails, other interventions are necessary to prevent the spread of disease. Numerous
studies have helped to identify additional barriers to the spread of faecal-oral disease. Many of
these barriers are related to behaviours such as good personal and domestic hygiene practices,
water storage and food preparation. Therefore, behaviour modifications as well as technical
sanitation solutions are necessary to reduce the transmission of excreta-related disease. Although
the guidelines under consideration in this book focus on water- related areas, it is clear from a
public health perspective that consideration of sanitation provision, under the auspices of the
harmonised framework, is vital in terms of both international guidelines and national standards.

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