ONE HEALTH APPROACH FOR THE PREVENTION OF OPEN DEFECATION: A PANACEA FOR OPEN DEFECATION-DRIVEN NEGLECTED TROPICAL DISEASES IN SUB-SAHARAN AFRICA – Frontiers

Report on Open Defecation and its Impact on Sustainable Development Goals

Introduction: The Sanitation Crisis as a Barrier to Sustainable Development

The practice of open defecation, by both humans and animals, presents a significant impediment to the achievement of the 2030 Agenda for Sustainable Development. This practice facilitates the transmission of parasites responsible for several Neglected Tropical Diseases (NTDs) by contaminating essential environmental resources. The complex life cycles of these parasites, which involve multiple hosts and environmental stages, are sustained by the improper disposal of feces. This report analyzes the linkage between open defecation and the proliferation of specific NTDs, framing the issue within the context of the Sustainable Development Goals (SDGs) and advocating for an integrated “One Health” approach as a sustainable solution, particularly for Sub-Saharan Africa.

Direct Challenge to SDG 3: Good Health and Well-being

Open defecation directly undermines progress towards SDG 3 by perpetuating the cycle of diseases that cause significant morbidity and mortality. The environmental contamination resulting from this practice enables the successful transmission and spread of several “Open Defecation-Driven NTDs,” including:

• Soil-Transmitted Helminthiasis
• Schistosomiasis
• Taeniasis
• Cysticercosis
• Echinococcosis

The failure to manage both human and animal waste creates a persistent public health threat, making the control and elimination of these diseases exceptionally challenging and hindering the attainment of universal health coverage and well-being for all.

Failure to Achieve SDG 6: Clean Water and Sanitation

The core of the problem lies in the failure to meet the targets of SDG 6, which calls for universal access to clean water and sanitation. While initiatives such as WASH (Water, Sanitation, and Hygiene) have demonstrated potential, their effectiveness is severely compromised by continued open defecation. The key consequences include:

• Soil Contamination: Fecal matter deposits parasites and pathogens directly into the soil, creating reservoirs of infection.
• Water Pollution: Runoff from contaminated areas pollutes rivers, lakes, and groundwater, compromising safe drinking water sources.
• Crop Contamination: The use of contaminated water for irrigation or the direct fertilization with untreated waste leads to contaminated food supplies, creating a direct route for ingestion of parasites.

A notable gap in current strategies is the insufficient attention given to animal open defecation, which, in the absence of specific environmental legislation, remains a major, unregulated source of environmental pollution and disease transmission.

An Integrated Solution Aligned with SDG 17: Partnerships for the Goals

A lasting solution requires a multi-sectoral, integrated strategy that aligns with the principles of SDG 17. The “One Health” approach, which recognizes the interconnection between human, animal, and environmental health, provides a comprehensive framework for tackling this complex issue. Implementing a One Health strategy is essential for creating the synergistic partnerships needed to break the cycle of NTD transmission.

Recommendations for an Integrated “One Health” Framework

To effectively combat open defecation-driven NTDs and advance the SDGs, the following integrated actions are recommended:

1. Unified Sanitation Policies: Develop and enforce policies that address both human and animal waste management, closing the legislative gap concerning animal defecation.
2. Cross-Sectoral Collaboration: Foster partnerships between public health authorities, veterinary services, environmental agencies, and community leaders to implement coordinated interventions.
3. Enhanced WASH Initiatives: Expand WASH programs to include education on the risks of animal feces and promote safe animal husbandry practices alongside improvements in human sanitation infrastructure.
4. Environmental and Food Safety: Integrate environmental monitoring and food safety protocols into NTD control programs to mitigate risks from contaminated soil, water, and crops, thereby contributing to SDG 12 (Responsible Consumption and Production) and SDG 15 (Life on Land).

By adopting a “One Health” approach, stakeholders can create a sustainable impact that not only controls specific NTDs but also contributes broadly to achieving global health, sanitation, and environmental goals.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s primary focus is on Neglected Tropical Diseases (NTDs) such as Soil-Transmitted Helminthiasis, Schistosomiasis, Taeniasis, Cysticercosis, and Echinococcosis. It directly discusses the spread of these diseases and the resulting health impacts on populations, which is a core component of SDG 3.
2. SDG 6: Clean Water and Sanitation
   • The article explicitly identifies “open defecation” as a “menace” that contaminates “soil, water, and crops.” It also mentions “WASH (Water, Sanitation, and Hygiene) initiatives” as a preventive strategy. This directly addresses the goals of improving sanitation and ensuring access to clean water.
3. SDG 15: Life on Land
   • The article discusses how parasites depend on “multiple hosts and different environmental elements,” including contamination of the soil. It highlights the role of both human and “animal open defecation” in polluting the environment. The proposed “One Health integrated approach” inherently connects human health, animal health, and the health of the terrestrial environment, which is central to SDG 15.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.3: End the epidemics of… neglected tropical diseases and combat… water-borne diseases
   • The article is entirely centered on the spread of specific NTDs and explores strategies to control them. It explicitly names “Soil-Transmitted Helminthiasis, Schistosomiasis, Taeniasis, Cysticercosis, and Echinococcosis” as “Open defecation driven-NTDs,” directly aligning with the goal of ending these epidemics.
2. Target 6.2: Achieve access to adequate and equitable sanitation and hygiene for all and end open defecation
   • The article identifies “open defecation” as the core driver of the problem. It states that this practice “contributes significantly to the spread of these parasites” and that “improper feces disposal has offset” the achievements of WASH initiatives. This directly corresponds to the target of ending open defecation.
3. Target 6.3: Improve water quality by reducing pollution
   • The text mentions that open defecation leads to “contaminating the environment, especially soil, water, and crops.” This fecal contamination is a form of water pollution that this target aims to reduce.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Implied Indicator for Target 3.3: Incidence and prevalence of specific NTDs
   • The article’s focus on the “spread” of diseases like Soil-Transmitted Helminthiasis and Schistosomiasis implies that a key measure of success would be the reduction in the number of people affected by these diseases. This aligns with the official indicator 3.3.5 (Number of people requiring interventions against neglected tropical diseases).
2. Implied Indicator for Target 6.2: Prevalence of open defecation
   • The article frames “open defecation” as the central problem. Therefore, measuring the proportion of the population that practices it is the most direct way to track progress toward its elimination, as mentioned in the article. This corresponds to the official indicator 6.2.1a (Proportion of population practicing open defecation).
3. Implied Indicator for Target 6.3: Level of environmental contamination
   • The article states that feces “contaminate and pollute the environment.” An implied indicator would be the measurement of fecal coliforms or parasite presence in soil and water samples to assess the level of environmental pollution, which is a way to measure progress in reducing this specific type of pollution.

4. Table of SDGs, Targets, and Indicators

Source: frontiersin.org