INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

Assessing Hygiene Risks: Microbial Contamination on Surfaces of

Public and Household Latrines at the District Level in Ghana.

Williams Ampadu Oduro ^1*, Eunice Eduful ²

¹Department of Biological, Environmental and Occupational Health, School of Public Health, University of Ghana, Legon,

Accra, Ghana

²Wisconsin International University College, Ghana.

*Corresponding author

DOI: https://doi.org/10.51583/IJLTEMAS.2025.1410000137

Received: 06 November 2025; Accepted: 14 November 2025; Published: 21 November 2025

Abstract: Latrines play a critical role in maintaining public health but can also act as reservoirs for microbial contamination,

particularly in low-resource settings. This cross-sectional study assessed hygiene risks by quantifying microbial loads on high-

touch surfaces of public and household latrines in Ghana. A total of 200 surface swabs were collected with 80 from public latrines

and 120 from household toilets. Samples were analyzed for Escherichia coli, Staphylococcus aureus, and total coliforms using

standard culture methods. Results were expressed as log₁₀ colony-forming units per square centimeter (CFU/cm²). Mean microbial

loads were significantly higher on surfaces of public latrines than on household toilets (p < 0.05). Door handles and flush levers

showed the greatest contamination, with E. coli reaching 3.82 ± 0.41 log₁₀ CFU/cm² in public latrines compared with 1.61 ± 0.32

log₁₀ CFU/cm² in household toilets. Cleaning frequency and disinfectant use were inversely associated with surface contamination.

These findings demonstrate that communal sanitation facilities may pose greater hygiene risks than private toilet facilites due to

inadequate cleaning and overcrowding. Strengthening sanitation management through regular disinfection, adequate maintenance,

and user hygiene education is essential to reduce potential pathogen exposure and improve overall environmental health.

Keywords: Public latrines, Microbial contamination, Escherichia coli, Hygiene practices, High-touch surfaces

I. Introduction

Access to safe sanitation remains a major public health challenge, particularly for rural households in low- and middle-income

countries. Globally, only about 57% of people have safely managed sanitation, while over 1.5 billion lack basic toilet facilities and

nearly 419 million still practice open defecation (WHO, 2024b). In sub-Saharan Africa, the situation is even more severe, with

nearly 68% of the population lacking adequate sanitation. Poor sanitation contributes to hundreds of thousands of diarrhoeal deaths

each year and helps spread intestinal parasites, typhoid, and cholera (WHO, 2024a).

Rapid urbanization, population growth, and weak municipal infrastructure have intensified these challenges in Africa. Many urban

and peri-urban areas rely heavily on public or communal latrines due to insufficient household toilets (Sprouse et al., 2024;Lebu et

al., 2024;Kan-uge, et al., 2019). Poverty, limited space, and land ownership constraints prevent some families from constructing

private toilets, making shared facilities a practical solution for millions (Obeng et al., 2023). However, such facilities can become

reservoirs of microbial contamination, especially when poorly managed. According to the United Nations (UN) Sustainable

Development Goals (SDGs), toilets shared by more than one household are not considered “safely managed” under SDG 6.2

(UNSD, 2024).

Public toilets are particularly prone to microbial contamination on high-touch surfaces such as door handles, flush buttons, toilet

seats, and nearby walls. Contamination arises from unwashed hands, inadequate cleaning, or aerosolized droplets released during

flushing, allowing bacteria such as Escherichia coli, Salmonella spp., and Staphylococcus aureus to persist (Gerba et al., 2025).

Studies in Côte d’Ivoire and Ghana have detected these bacteria on university, market, school, and transport hub toilets (N’gbesso

et al., 2020;Donkor et al., 2020;Obeng et al., 2023).

The possible routes through which microbes spread in public and household latrines include direct contact with contaminated

surfaces, exposure to aerosols generated during flushing, and poor cleaning or disinfection practices (Figure 1).

Despite improvements in sanitation coverage, public toilets remain essential in many Ghanaian communities. According to the

2021 Population and Housing Census, about 59.3% of households had access to a toilet facility, nearly one in four relied on public

toilets, and approximately 17.7% had none (GSS, 2021; Asiedu, 2025). The benefits of public toilets are often undermined by

inconsistent cleaning, inadequate water or soap supply, and poor maintenance. Studies across several Ghanaian towns report broken

infrastructure, foul odors, and irregular disinfection, all of which increase the risk of disease transmission (The Ghana Report,

2022).

www.ijltemas.in

Page 1128

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

Fig. 1. Pathways of microbial transmission in public and household latrines.

Source: Author’s construct (2025).

These sanitation challenges are particularly evident in mixed urban–rural settings in Ghana’s Eastern Region, where manyresidents,

students, and visitors rely on public latrines daily. Originally built for short-term use during funerals, festivals, and other gatherings,

many of these facilities now serve as permanent sanitation options. Limited maintenance, poor user behavior, and irregular cleaning

have worsened their condition, and some users engage in unhygienic acts such as touching or smearing walls, further increasing

contamination risks.

Against this background, this study aimed to assess the microbial contamination of frequently touched surfaces in both public and

household latrines, identify which surfaces pose the highest infection risk, and examine how maintenance practices affect

contamination levels. The findings are expected to inform interventions that improve sanitation and promote safer use of public

toilet facilities in Ghana and other developing countries.

II. Materials and Methods

2.1 Study Area

The study was conducted in the Akuapem North Municipality, located in the Eastern Region of Ghana. The municipality comprises

towns including Akropong, Mampong, Larteh, Adawso, and Okorase. It is a mixed urban–rural area with significant commuter and

resident populations, many of whom rely on public latrines. Public latrines in this area vary in design, maintenance, and user traffic,

which provides an ideal setting for assessing microbial contamination on frequently touched surfaces.

Figure 2: Map of Akuapem North Municipality (Owusu, et al. 2015)

www.ijltemas.in

Page 1129

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

2.2 Study Design

A cross-sectional survey was conducted to capture a snapshot of microbial contamination on high-touch surfaces in both public and

household latrines, as well as hygiene and maintenance practices at a single point in time.

2.3 Selection of Public Latrines and Households

Twentypublic latrines and 30 household toilets were purposivelyselected to compare contamination between communal and private

facilities. Household selection ensured representation across the municipality, ease of access, and consent from the household head.

Caretakers and household heads were made to provide verbal consent before sampling.

2.4 Sampling Strategy

Four high-touch surfaces per site were swabbed: door handles, flush buttons/levers, walls near defecation points (10 cm²), and

squat/seat surfaces. Sterile cotton swabs moistened with saline were used, then placed in labeled sterile transport tubes containing

buffered peptone water. Tubes were sealed and transported in cool boxes at 4–8 °C, and processed within six hours to maintain

sample integrity. Negative control swabs were included to ensure no contamination occurred during handling or transport (West et

al., 2023 ; Prentice-Mott et al., 2024).

2.5 Sample size

A total of 200 surface swabs were collected: 80 from public latrines and 120 from household toilets. This allowed sufficient

variability to compare contamination across facilities, surface types, and zones.

2.6 Microbiological Analysis

Swabs were vortexed in sterile saline, plated on MacConkey agar for E. coli and total coliforms, and Mannitol Salt agar for S.

aureus. Plates were incubated at 37 °C for 24–48 hours, and colony counts recorded as log₁₀ CFU/cm². Presumptive colonies were

confirmed using standard biochemical tests. Positive and negative controls were run to validate results (Fontana et al., 2025;Dahlin

et al., 2024).

2.7 Data and metadata collection

For each site, data recorded included site type, zone, site identifier, surface type, date/time, observed cleaning frequency,

disinfectant use, and visible cleanliness. This allowed stratified and multivariable analyses to explore factors associated with

contamination.

2.8 Data Analysis

Data were cleaned in Excel and analyzed in SPSS version 25. Microbial counts were expressed as log₁₀ CFU/cm² and summarized

as mean ± SD. The Shapiro–Wilk test was used to check whether the data followed a normal distribution. For normally distributed

data, independent-samples t-tests were conducted, and 95% confidence intervals (CI) were calculated to show the precision of the

mean differences. For data that were not normally distributed, the Mann–Whitney U test was used. Statistical significance was

considered at p < 0.05.

2.9 Ethical Considerations

Although this study involved only environmental sampling and did not collect human specimens or personal identifiers, ethical

approval was obtained from the Ghana Health Service Ethics Review Committee (Ref. No. GHS/RDD/ERC/Admin/App/23/008).

In addition, formal authorization for the research was secured from the Akuapem North Municipal Environmental Health Office.

Permission from public latrine caretakers and household heads was also obtained prior to sample collection to ensure adherence to

local administrative and ethical standards.

III. Results

3.1 Surface microbial contamination

Microbial contamination was detected on all sampled surfaces of both public latrines and household toilets, with significantly higher

counts observed in public latrines (p < 0.05) (Table 1). Door handles showed the highest contamination levels, with mean E. coli

and total coliform counts of 3.82 ± 0.41 and 4.53 ± 0.48 log₁₀ CFU/cm², respectively, in public latrines, compared with 1.61 ± 0.32

and 2.01 ± 0.38 log₁₀ CFU/cm² in household toilets. Similarly, flush buttons or levers demonstrated elevated microbial loads in

public latrines (E. coli: 3.54 ± 0.37; total coliforms: 4.05 ± 0.42 log₁₀ CFU/cm²) relative to household toilets. Squat or seat surfaces

and wall areas also retained notable contamination, though at slightly lower levels than contact surfaces such as handles and flush

levers.

S. aureus counts followed a similar trend, ranging from 0.91–2.12 log₁₀ CFU/cm² in public latrines and 0.43–0.83 log₁₀ CFU/cm²

in household toilets. These differences were statistically significant across all surface types (p < 0.05).

Table 1: Mean (±SD) microbial contamination (log₁₀ CFU/cm²) on selected surfaces of public latrines (n = 80) and household toilets

(n = 120), Akuapem North Municipality

www.ijltemas.in

Page 1130

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

Surface type

Door handles

Microorganism Public latrine (Mean ± SD) Household toilet (Mean ± SD) p-value

E. coli

3.82 ± 0.41

2.12 ± 0.36

4.53 ± 0.48

3.54 ± 0.37

1.91 ± 0.25

4.05 ± 0.42

2.73 ± 0.33

1.64 ± 0.28

3.21 ± 0.35

1.82 ± 0.27

0.91 ± 0.15

2.09 ± 0.24

1.61 ± 0.32

0.83 ± 0.22

2.01 ± 0.38

1.39 ± 0.29

0.72 ± 0.19

1.76 ± 0.31

1.19 ± 0.25

0.63 ± 0.18

1.37 ± 0.27

0.81 ± 0.21

0.43 ± 0.12

0.88 ± 0.19

<0.001

0.002

S. aureus

Total coliforms

E. coli

Flush buttons/levers

Squat/seat surfaces

Wall areas (10 cm²)

S. aureus

Total coliforms

E. coli

S. aureus

0.004

Total coliforms

E. coli

0.003

0.005

S. aureus

0.008

Total coliforms

0.006

Note. Values represent mean ± standard deviation (SD) of microbial counts expressed as log₁₀ CFU/cm². p-values were obtained

using independent-samples t-tests (or Mann–Whitney U tests for non-normally distributed data). Statistical significance was set at

p < 0.05.

3.2 Cleaning frequency and disinfection practices

Figure 3 illustrates the mean microbial loads (log₁₀ CFU/cm²) on public latrine surfaces according to cleaning frequency and

disinfectant use. Surfaces cleaned once daily recorded a mean microbial load of approximately 3.61 log₁₀ CFU/cm², whereas those

cleaned twice daily showed a slightly lower mean of 3.45 log₁₀ CFU/cm². Similarly, facilities that did not use disinfectants exhibited

higher microbial loads (3.63 log₁₀ CFU/cm²) compared with those that applied disinfectants (3.41 log₁₀ CFU/cm²).

Fig.3 Cleaning frequency and disinfectant use across public latrines and household toilets

3.3 Comparison of overall contamination between facility types

Table 2 compares mean microbial loads on selected surfaces of public latrines and household toilets. All surfaces showed detectable

contamination, with public latrine surfaces consistently exhibiting higher mean counts (p < 0.05). Door handles recorded the highest

levels (4.20 ± 1.10 log₁₀ CFU/cm²) in public latrines which is approximately double those in household toilets (2.10 ± 0.72 log₁₀

CFU/cm²). Similar trends were observed for toilet seats/squat areas and flush buttons/levers. The overall mean microbial load (3.74

± 1.02 log₁₀ CFU/cm²) in public latrines was nearly twice that of household toilets (1.86 ± 0.65 log₁₀ CFU/cm²).

www.ijltemas.in

Page 1131

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

Table 2. Comparison of Mean Microbial Loads (log₁₀ CFU/cm²) Between Public Latrine and Household Toilet Surfaces

Surface Type

Public Latrine

(Mean ± SD,

95% CI

Household Toilet

(Mean ± SD,

95% CI

p-value

log₁₀ CFU/cm²)

Door handles

4.20 ± 1.10

3.96–4.44

2.10 ± 0.72

1.92 ± 0.55

1.74 ± 0.61

1.68 ± 0.58

1.86 ± 0.65

1.97–2.23

<0.001

0.002

0.004

0.005

<0.001

Toilet seats/squat area 3.68 ± 0.89

Flush buttons/levers 3.42 ± 0.80

Walls near toilet area 3.18 ± 0.76

Overall mean 3.74 ± 1.02

3.49–3.87

3.25–3.59

3.01–3.35

3.52–3.96

1.82–2.02

1.63–1.85

1.58–1.78

1.74–1.98

Note: Values are presented as mean ± standard deviation (SD) of microbial counts in log₁₀ CFU/cm². The 95% confidence intervals

(CI) indicate the range within which the true mean is likely to fall. P-values were obtained using independent-samples t-tests, and

statistical significance was set at p < 0.05.

IV. Discussion

This study assessed microbial contamination on frequently touched surfaces in public and household latrines in the Akuapem North

Municipality. All 200 swab samples, including 80 from public latrines and 120 from household toilets, showed microbial presence,

with public facilities consistently showing higher bacterial loads. Door handles, flush levers, and walls near defecation points were

the most contaminated surfaces. This indicates areas of greatest exposure risk.

The predominance of E. coli, Staphylococcus aureus, and total coliforms indicates persistent fecal and skin-associated

contamination. These findings align with studies in similar contexts. Chijioke & Adaeze, (2024), reported significant contamination

on hostel toilet door handles, mainly S. aureus, while Donkor et al., (2020) found that 20.2% of public toilet door handles in Ghana

were contaminated with the same bacteria. This indicated limited cleaning and poor hygiene practices. Frequent contact with

inadequately washed hands is likely a key factor in microbial transfer (Traoré et al., 2024).

Quantitatively, the overall mean microbial load in public latrines (3.74 ± 1.02 log₁₀ CFU/cm²) was about twice that observed in

household toilets (1.86 ± 0.65 log₁₀ CFU/cm²), giving a mean ratio of 2.01 (95% CI: 1.77–2.29). Similarly, E. coli levels on public

latrine door handles (3.82 ± 0.41 log₁₀ CFU/cm²) were 2.37 times higher (95% CI: 2.10–2.68) than those on household door handles

(1.61 ± 0.32 log₁₀ CFU/cm²). S. aureus loads followed a similar pattern, with public latrine surfaces showing values roughly 2.5 to

3 times higher than those from household toilets. These confidence intervals confirm that the observed differences were not random

but show consistent and significant disparities between facility types.

Walls near defecation points recorded notable bacterial loads, and this is likely due to aerosolized droplets generated during flushing

(Crimaldi et al., 2022; Vardoulakis et al., 2022). In contrast, flush buttons and levers showed lower contamination, possibly because

their smooth surfaces are easier to clean, less exposed to fecal matter, and made of materials less conducive to microbial survival

(Gerba et al., 2025). This observation highlights the role of surface type, design, and material in bacterial persistence.

Cleaning practices and the use of disinfectants influenced microbial levels. Surfaces cleaned once daily or without disinfectants had

higher contamination (3.61 log₁₀ CFU/cm²) compared with those cleaned twice daily with disinfectants (3.45 log₁₀ CFU/cm²).

Although the numerical difference appears small (mean difference = 0.16 log₁₀ CFU/cm²; 95% CI: 0.10–0.22), this represents

roughly a 1.45-fold reduction in bacterial load, an effect that becomes meaningful when sustained over time. Similar findings were

reported by Hamed et al. (2024) and Mraz et al., (2023). This comfirms that frequent cleaning combined with effective disinfectants

significantly reduces microbial presence. However, routine cleaning without appropriate disinfectants may therefore be insufficient

to control contamination in heavily used shared facilities.

Behavioral factors and facility management further influenced contamination levels. Overcrowding, overuse of public toilets

originally designed for transient use, and inconsistent cleaning likely contributed to higher bacterial presence. Similar patterns were

observed in Côte d’Ivoire, where 60–70% of public toilet surfaces were contaminated (N’gbesso et al., 2020). Studies from Nepal

also showed that effective maintenance and responsible user behavior can significantly reduce contamination, even in communal

facilities (McGinnis et al., (2019).

The contamination of frequently touched surfaces poses real public health risks. E. coli can cause urinary tract infections,

gastroenteritis, and systemic illnesses, while S. aureus, including methicillin-resistant strains (MRSA), is responsible for skin,

wound, and bloodstream infections (Fankem et al., 2006; Ibrahim et al., 2024). The difference in average microbial load between

public and household toilets (1.88 log₁₀ CFU/cm², 95% CI: 1.50–2.20) means that surfaces in public facilities carry almost 100

times more bacteria, which indicates a higher risk of contamination. This has real-world implications, especially for children and

individuals with limited hygiene awareness, who may easily transfer pathogens from contaminated surfaces to their mouths or food.

www.ijltemas.in

Page 1132

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

In low-resource settings, such exposures can lead to severe infections due to limited access to clean water, healthcare, and hygiene

materials.

The findings of the study indicate the importance of maintaining good sanitation and hygiene practices. While public latrines are

essential for many communities, their safety depends on regular cleaning, proper disinfection, and a continuous supply of water

and soap. Hygiene education is also necessary to minimize microbial contamination. Promoting hygiene education and supporting

household-level sanitation could reduce reliance on shared facilities, limit infection risks, and promote safer and more sustainable

sanitation practices.

Limitations

This study provides a snapshot of contamination at a single point in time, so it may not capture how microbial levels change

throughout the day or over time. The analysis focused only on bacteria that could be cultured in the laboratory, which means other

microorganisms such as non-culturable bacteria and viruses may not have been detected. Finally, since the study was conducted

within one municipality, the results may not be fully generalizable to other settings with different sanitation systems, environmental

conditions, or hygiene behaviors.

V. Conclusion

Public latrines in the Akuapem North Municipality had higher bacterial contamination than household toilets, with door handles,

flush levers, and walls being the most affected. Insufficient cleaning, inconsistent disinfection, and overcrowding sustain microbial

persistence in communal facilities. Regular cleaning with effective disinfectants, hygiene education, and reliable water and soap

provision are essential. Supporting household-level sanitation could reduce reliance on public facilities and lower infection risks.

Future studies should adopt longitudinal designs and molecular methods to better understand microbial dynamics and assess the

impact of hygiene interventions over time.

Funding

The study was self-funded.

Data availability

The datasets generated and/or analyzed in this study are not publicly accessible but can be made available by the corresponding

author upon reasonable request.

Consent for publication

Not applicable

Conflict of interest

There are no conflicting interests declared by the authors.

Acknowledgments

The authors express their gratitude to the Chief and elders of the Noyem community in the Birim North District for their support.

We also sincerely appreciate the assistance of the Assembly Member, who contributed during the sample collection process.

Author contributions

Williams Ampadu Oduro designed the study and drafted the paper, Eunice Eduful collected and the cleansed the data, Williams

Ampadu Oduro revised the draft paper and wrote the manuscript. All authors reviewed the manuscript.

References

1. Asiedu, G. (2025). Achieving universal access to toilet facilitiesꢀ: Let ’ s build more lavatories — GAMA Project

Coordinator Ghana has made strides towards achieving universal access to toilet facilities

1–5.

https://www.ghanamma.com/2022/11/19/achieving-universal-access-to-toilet-facilities-lets-build-more-lavatories-gama-

project-coordinator/?utm

2. Chijioke, I., & Adaeze, C. N. (2024). Evaluation Of Salmonella species , Escherichia coli And Staphylococcus aurues

Associated With Toilet Door Handles At Girls And Boys Hostels In Federal Polytechnic Of Oil And Gas Bonny For A

Direct Link To Typhoid Fever And Other Related Diseases On Studen. 12(2), 46–55.

3. Crimaldi, J. P., True, A. C., Linden, K. G., Hernandez, M. T., Larson, L. T., & Pauls, A. K. (2022). Commercial toilets

emit energetic and rapidly spreading aerosol plumes. Scientific Reports, 12(1), 1–9. https://doi.org/10.1038/s41598-022-

24686-5

4. Dahlin, L., Hansson, I., Fall, N., Sannö, A., & Jacobson, M. (2024). Development and evaluation of a standardised

sampling protocol to determine the effect of cleaning in the pig sty. Porcine Health Management, 10(1), 1–9.

https://doi.org/10.1186/s40813-024-00400-x

5. Donkor, E. S., Nana, N. E., & Akumwena, A. (2020). Making a Case for Infection Control at Public Places of Convenience

www.ijltemas.in

Page 1133

INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,

MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)

ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XIV, Issue X, October 2025

in Accra, Ghana. Environmental Health Insights, 14(July 2017). https://doi.org/10.1177/1178630220938414

6. Fankem, S., Kennedy, D., Enriquez, C., & Gerba, C. (2006). Assessment of Enteric Pathogen Exposure in Public Toilets.

Epidemiology, 17(Suppl), S457. https://doi.org/10.1097/00001648-200611001-01228

7. Fontana, R., Vogli, L., Buratto, M., Caproni, A., Nordi, C., Pappadà, M., Facchini, M., Buffone, C., Bandera, B., &

Marconi, P. (2025). Environmental Microbiological Sampling in Civil Settings: Comparative LCA Analysis of Green

Cleaning Techniques vs. Traditional Methods in Accordance with New Italian CAM Guidelines. Sustainability

(Switzerland), 17(10), 1–14. https://doi.org/10.3390/su17104546

8. Gerba, C. P., Boone, S. A., McKinney, J., & Ijaz, M. K. (2025). Bacterial Contamination of Public and Household

Restrooms, and Implications for the Potential Risk of Norovirus Transmission. Hygiene, 5(3), 27.

https://doi.org/10.3390/hygiene5030027

9. Ghana

Statistical

Service

(GSS).

(2021).

2021

Population

and

Housing

Census.

2021.

https://doi.org/https://census2021.statsghana.gov.gh/

10. Grace L. Baldwin Kan-uge, E. K. and R. M. S. I. (2019). West Africa. Journal of Commonwealth Literature, 54(4), 715–

720. https://doi.org/10.1177/0021989419877067

11. Hamed, N. M. H., Deif, O. A., El-Zoka, A. H., Abdel-Atty, M. M., & Hussein, M. F. (2024). The impact of enhanced

cleaning on bacterial contamination of the hospital environmental surfaces: a clinical trial in critical care unit in an

Egyptian hospital. Antimicrobial Resistance and Infection Control, 13(1). https://doi.org/10.1186/s13756-024-01489-z

12. Ibrahim, K., Tahsin, M., Rahman, A., Rahman, S. M., & Rahman, M. M. (2024). Surveillance of Bacterial Load and

Multidrug-Resistant Bacteria on Surfaces of Public Restrooms. International Journal of Environmental Research and

Public Health, 21(5). https://doi.org/10.3390/ijerph21050574

13. Kwadwo Owusu, Peter Bilson Obour, and S. A.-B. (2015). Handbook of Climate Change Adaptation. Handbook of

Climate Change Adaptation, March, 1–2198. https://doi.org/10.1007/978-3-642-38670-1

14. Lebu, S., Sprouse, L., Akudago, J. A., Baldwin-SoRelle, C., Muoghalu, C. C., Anthonj, C., Evans, B., Brown, J., Bartram,

J., & Manga, M. (2024). Indicators for evaluating shared sanitation quality: a systematic review and recommendations for

sanitation monitoring. Npj Clean Water, 7(1). https://doi.org/10.1038/s41545-024-00386-7

15. McGinnis, S., Marini, D., Amatya, P., & Murphy, H. M. (2019). Bacterial contamination on latrine surfaces in community

and household latrines in Kathmandu, Nepal. International Journal of Environmental Research and Public Health, 16(2).

https://doi.org/10.3390/ijerph16020257

16. Mraz, A. L., McGinnis, S. M., Marini, D., Amatya, P., & Murphy, H. M. (2023). Impact of usership on bacterial

contamination of public latrine surfaces in Kathmandu, Nepal.

https://doi.org/10.1371/journal.pwat.0000091

PLOS Water, 2(2), 1–17.

17. N’gbesso, N. J.-P., Félicité, B., N’guessan, O. N. A. N., Serge, M., Arra, J. L. A., & Ahoua, A. A. C. (2020). Prevention

of Gastrointestinal Pathologies: Comparative Study of the Microbial Flora of the Sanitary Surfaces of the Toilets of

Students and Staff of the Félix Houphouët-Boigny University. Open Journal of Medical Microbiology,

10(03), 129–138. https://doi.org/10.4236/ojmm.2020.103011

18. Obeng, P. A., Awere, E., Obeng, P. A., Oteng-Peprah, M., Mwinsuubo, A. K., Bonoli, A., & Quaye, S. A. (2023). Usage

and Microbial Safety of Shared and Unshared Excreta Disposal Facilities in Developing Countries: The Case of a Ghanaian

Rural District. Sustainability (Switzerland), 15(13). https://doi.org/10.3390/su151310282

19. Prentice-Mott, G., Maru, L., Kossik, A., Mugambi, E. M., Ombok, C., Odinoh, R., Mwikali, F., Rosenberg, R., Ngere, I.,

Murphy, J., & Berendes, D. (2024). ATP-based assessments of recent cleaning and disinfection for high-touch surfaces in

low-resource shared toilets. Npj Clean Water, 7(1), 1–20. https://doi.org/10.1038/s41545-024-00380-z

20. Sprouse, L., Lebu, S., Nguyen, J., Muoghalu, C., Uwase, A., Guo, J., Baldwin-SoRelle, C., Anthonj, C., Simiyu, S. N.,

Akudago, J. A., & Manga, M. (2024). Shared sanitation in informal settlements: A systematic review and meta-analysis

of prevalence, preferences, and quality. International Journal of Hygiene and Environmental Health, 260, 2024–2025.

https://doi.org/10.1016/j.ijheh.2024.114392

21. The Ghana Report. (2022). Why There Is Urgent Need To Improve Access To Toilet Facilities In Ghana.

https://www.theghanareport.com/why-there-is-urgent-need-to-improve-access-to-toilet-facilities-in-ghana/?utm

22. Traoré, S. G., Fokou, G., Wognin, A. S., Dié, S. A. G., Amanzou, N. A. A., Heitz-Tokpa, K., Tetchi, S. M., Seko, M. O.,

Sanhoun, A. R., Traoré, A., Anoh, E. A., Tiembre, I., Koussemon-Camara, M., Akoua-Koffi, C., & Bonfoh, B. (2024).

Assessment of handwashing impact on detection of SARS-CoV-2, Staphylococcus aureus, Escherichia coli on hands in

rural and urban settings of Côte d’Ivoire during COVID-19 pandemic. BMC Public Health, 24(1), 1–12.

https://doi.org/10.1186/s12889-024-18838-7

23. UNSD. (2024). SDG indicator metadata. Https://Ourworldindata.Org/Natural-Disasters#, 24(July), 1–28.

https://unstats.un.org/sdgs/metadata/files/Metadata-11-03-01.pdf

24. Vardoulakis, S., Espinoza Oyarce, D. A., & Donner, E. (2022). Transmission of COVID-19 and other infectious diseases

in public washrooms:

systematic review. Science of the Total Environment, 803, 149932.

https://doi.org/10.1016/j.scitotenv.2021.149932

25. West, R. M., Shams, A. M., Chan, M. Y., Rose, L. J., & Noble-Wang, J. A. (2023). Surface area matters: An evaluation

of swabs and surface area for environmental surface sampling of healthcare pathogens. Infection Control and Hospital

Epidemiology, 44(5), 834–836. https://doi.org/10.1017/ice.2022.101

www.ijltemas.in

Page 1134