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Background and Situation AnalysisThe importance of Water Sanitation and Hygiene (WASH) projects for the protection of health is embedded in the sustainable development goals. However, within the development and humanitarian fields sustainability of WASH projects is still a challenge with 30–50% of projects failing within two to five years of implementation. Though failure is not linked to any one source, a common theme speaks to a greater need for community engagement and integration of the wants and needs of the end-user in the design process. Social marketing, with its focus on the consumer and use of commercial marketing strategies to achieve behavior change is a promising approach that can be integrated into ongoing WASH initiatives to meet program outcomes and to achieve long-term sustainability. Priority audiencePrimary audience includes technicians who manufacture and repair pitcher pumps. Secondary audience includes community members in Toamasina, Madagascar, who will experience a decrease in exposure to lead through their water supply. Behavioral objectivesDecrease exposure to lead (Pb) introduced through the use of a decentralized, self-supply water system, the pitcher pump. Specifically, decrease use of leaded components in the manufacturing and repair of pitcher-pumps Strategy/InterventionDevelopment of the intervention followed the social marketing process including conducting a situational analysis, identification and selection of a behavioral focus and priority population, formative research, development of an integrated marketing strategy, pretesting the strategy, followed by campaign implementation, and monitoring and evaluation. An intervention focused on building a sense of community and introducing the element of professionalism for the pump manufacturers was developed, consisting of personalized one-on-one outreach to raise awareness of the health topic, followed by skill building trainings on how to make the switch to non-leaded components. This was coupled with tangible products that created a new professional network, documentation of work, and backing of work by trusted government entities. Evaluation Methods and ResultsUsing the theory of planned behavior, a pre/post-test summative evaluation was developed. Preliminary results indicate that pump technicians no longer use lead in pumps unless specifically requested by the pump owners. These results indicate a positive shift towards the use of lead-free components with project follow-up and analysis ongoing. Recommendations for Social Marketing PracticeUse of social marketing within the WASH sector is lacking. This paper demonstrates the integration of social marketing in an ongoing WASH project. Through a description of each step of the process, our experiences in implementing it and the lessons learned, we hope to guide future integration. Additionally, this paper demonstrates the convergence of engineers and social marketers working collaboratively on an interdisciplinary team and how this served to enhance project understanding, aid in building local partnerships and help with long-term sustainability. 

Tourism offers many economic benefits but can have long-lasting ecological effects when improperly managed. Tourism can cause overwhelming pressure on wastewater treatment systems, as in Belize, where some of the over 400 small islands (cayes) that were once temporary sites for fishermen have become popular tourist destinations. An overabundance of nitrogen, in part as a result of incomplete wastewater treatment, threatens human health and ecosystem services. The tourism industry is a complex and dynamic industry with many sectors and stakeholders with conflicting goals. In this study, a systems thinking approach was adopted to study the dynamic interactions between stakeholders and the environment at Laughing Bird Caye National Park in Belize. The project centered on nutrient discharges from the caye’s onsite wastewater treatment system. An archetype analysis approach was applied to frame potential solutions to nutrient pollution and understand potential behaviors over time. “Out of control” and “Underachievement” were identified as system archetypes; “Shifting the Burden” and ‘‘Limits to Success’’ were used to model specific cases. Based on these results, upgrading of the wastewater treatment system should be performed concurrently with investments in the user experience of the toilets, education on the vulnerability of the treatment system and ecosystem, and controls on the number of daily tourists. 

Urbanization and population growth in coastal communities increase demands on local food and water sectors. Due to this, urban communities are reimagining stormwater pond infrastructure, asking whether the stormwater can be used to irrigate food and grow fish for local consumption. Studies exploring this feasibility are limited in the literature. Driven by a community’s desire to co-locate community gardens with stormwater pond spaces, this research monitored the water quality of a 23.4-hectare stormwater pond located in East Tampa, Florida over one year using the grab sample technique and compared the results with U.S. Environmental Protection Agency (EPA) reuse recommendations, EPA national recommended water quality criteria for aquatic life, and human health. pH and conductivity levels were acceptable for irrigating crops. Heavy metal (arsenic, cadmium, copper, lead, and zinc) concentrations were below the maximum recommended reuse levels (100, 10, 200, 5000 and 2000 µg/L, respectively), while zinc and lead were above the criteria for aquatic life (120 and 2.5 µg/L, respectively). E. coli concentrations ranged from 310 to greater than 200,000 MPN/100 mL, above the 0 CFU/100 mL irrigation requirements for raw food consumption and 200 CFU/100 mL requirements for commercial food processing. Synthetic organic compounds also exceeded criteria for human health. 

With their numerous products and uses, multifunctional crops offer an attractive means for improving smallholder farmer livelihoods. This study applies a Life Cycle Sustainability Assessment (LCSA) to Moringa oleifera (moringa), a multifunctional crop with diverse applications in nutrition, cosmetics, and water treatment. The LCSA includes an Environmental Life Cycle Assessment (ELCA), Social Life Cycle Assessment (SLCA), and Life Cycle Costing (LCC). Surveys were conducted with 58 smallholder farmers and five moringa processors in Ghana. The ReCiPe 2016 Midpoint method was used for the ELCA. The 10-year Net Present Value (NPV) and Payback Period (PBP) were calculated for farmers and processors in the LCC. The SLCA focused on the Worker stakeholder category, particularly smallholder farmer impacts, including indicators for Next Generation Farming, Inclusiveness, Access to Services, Food Security, and Livelihood. A composite sustainability score was calculated from the ELCA, SLCA, and LCC results using the Characteristic Objects Method (COMET), a multi-criteria decision analysis method resistant to rank-reversal. The study compared five supply chains: leaf-only, leaf-and-seed, leaf-and-seed with seedcake reuse, seed-only, and seed-only with seedcake reuse. Environmental hotspots were identified in leaf and seed collection. Economically, leaf-only cultivation provided the highest 10-year NPV for farmers, while seed-only with seedcake reuse yielded the highest NPV for processors. The leaf-only supply chain had the best PBP for both farmers and processors. Socially, leaf-only cultivators outperformed reference points across all indicators, making it the most socially sustainable supply chain. Our findings highlight that improving market access, organizing seed cultivators into farmer-based groups, and optimizing farm gate product collection can enhance the sustainability of moringa supply chains, offering a model for other multifunctional crops in rural development. This study is the first to integrate LCSA with COMET, a promising approach that could be adopted in other sustainability assessment case studies. 

Household air pollution is a pervasive environmental health problem wherever access to cleaner fuels is poor. Despite numerous attempts to transition households away from polluting fuels, interventions are rarely sustainable. This intractability indicates that structural (i.e., systemic) dynamics act to maintain the status quo. In this case study of Ghana's Rural Liquefied Petroleum Gas (LPG) Promotion Program, our objectives were to 1) identify system structures affecting sustained fuel use, and 2) test strategies for improving intervention outcomes. To address these objectives, we applied a system dynamics approach, informed by a systematic literature review. A virtual simulation model was constructed to represent the implementation of the Rural LPG Program and its outcomes. By analyzing the model's structure and behavior, we proposed strategies that would improve the intervention's outcomes and tested the effectiveness of the strategies within the simulation model. Our results show that distributing two LPG cylinders to households (instead of one) contributed toward primary use of the fuel, whereas free weekly delivery of LPG (for up to four years) had limited long-term benefits and diminishing returns. Furthermore, reducing the time for users to perceive the benefits of cleaner fuels enhanced willingness-to-pay, and thereby helped to sustain higher rates of LPG use. This suggests that intervention planners should identify new users' expectations of benefits and proactively design ways to realize those benefits quickly (in a few weeks or less), while policy makers should support this as a design requirement in approval processes. 

Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households’ perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding. 

Poor sanitation causes 30% of diarrheal deaths globally, and much of the world has struggled to finance top-down interventions. Sanitation marketing is a demand-led approach that uses a mixture of social and commercial marketing methods and direct sales to households. However, little is known about its impacts on household decision making. This mixed-methods study uses data from eight focus groups and 86,666 household surveys from participants in a five-year sanitation marketing program in Uganda. Logistic regression models identified 10 variables predicting attainment of improved (limited or basic) sanitation and four variables predicting female involvement in decision making. Triggering session attendance increased chances of reaching improved sanitation by 15–28%, depending on who attended, and by 19% if the household found the session motivational. Although women were engaged in decision-making conversations, they were not viewed as primary decision makers, even in female-headed households. Women were more likely to become involved in decision making if they had attended triggering sessions with men (+70%) or engaged with sales promoters alone (+74%) or with men (+78%). For both outcomes, joint activity engagement was more effective than male or female engagement alone. This work highlights two sanitation marketing activities as pathways to improving latrine coverage and women’s decision-making agency. 

One in three children globally is estimated to have blood lead levels (BLL) at or above the BLL reference value of 5 μg/dL with increased burden falling on low- and middle-income countries (LMIC). Within developed countries, aqueous lead is the predominant exposure route. However, aqueous lead exposure is rarely examined in the LMIC, leaving a gap in the literature that ignores a potentially significant route of exposure. Furthermore, limited lead-based remediation efforts around consumer products have been examined. This study investigates the importance of lead exposure from the water supply through a case study in Toamasina, Madagascar. The project measured aqueous lead and BLL of children pre- and postremediation efforts (i.e., removal of leaded pump components in hand pumps) to verify the impact of aqueous lead exposure within this community. Removal of the leaded pump components (i.e., piston and foot valves) and replacement with nonleaded components decreased aqueous lead levels below the World Health Organization provisional guideline of 10 μg/L in all but 4% of pumps tested. Measured BLL concentrations indicated a statistically significant decrease in BLL from pre- to postremediation. Furthermore, the remediation resulted in a decrease in BLL for 87% of children with the greatest changes in BLL observed for children with the highest preremediation concentrations. These findings point to a need for greater consideration of lead in drinking and cooking waters as an important exposure route in LMIC. 

Coastal environments around the globe are subject to anthropogenic stresses due to dense coastal populations. The response of development activities on dynamic estuarine ecosystems, influenced by tidal forces, freshwater flows, salinity variations, and intricate coastal land morphology, is often uncertain. This case study evaluates how connectivity and coastal geomorphology influence flow patterns by modeling the effects of a proposed hydraulic reconnection project on water movement between the Manchester Waterway, a coastal residential community, and Charlotte Harbor, a large open water estuary in the Gulf of Mexico. An unstructured grid, 2D model was developed utilizing Delft3D Flexible Mesh to simulate estuary hydrodynamics under proposed conditions for four different weather conditions, including recorded 2021–2022 weather, future sea level rise, an extreme weather event, and a combination of extreme weather and sea level rise. Simulated flow results for proposed conditions were compared to present day flow patterns for analysis of the predicted changes in water levels and velocity magnitudes in the waterway. The results show that increased connectivity between the Manchester Waterway and Charlotte Harbor is expected to increase tidal amplitudes largely due to a lowering of minimum water levels in the waterway. During storm events, water elevations are predicted to drop to lower elevations following peak storm surge due to proposed conditions, which may provide flooding relief. Model simulation results will aid hydraulic reconnection and guide a more comprehensive ecological restoration plan. This case study will also improve understanding of the major influencing forces in intricate estuarine environments and how ecosystems may respond to land development, sea level rise, and increasing magnitude and frequency of tropical storms. 

In 2019, interdisciplinary teams of anthropology and environmental engineering PhD students went to Placencia Village, Belize to study stakeholder-driven issues related to coastal resilience. Our team explored wastewater management on a few of the more than 400 small cayes peppering the Belize Barrier Reef. These islands have transitioned from temporary sites for overnight fishers to crowded tourism destinations. Wastewater management has struggled to keep pace with these changes, spurring concerns about the health of the reef. Our task was to construct contextualized system dynamic models which would be useful to those concerned. Along the way however, we ran into tensions related to the underlying logic, and representations of people, in mathematical descriptions of social and technical configurations. This article lays out the context and lessons learned from our encounter with interdisciplinary systems modeling.