Environmental Challenges 8 (2022) 100589

Contents lists available at ScienceDirect

Environmental Challenges
journal homepage: www.elsevier.com/locate/envc

Disposable diaper waste accumulation at the human-livestock-wildlife

interface: A one health approach
Hilary Kordecki a, Romy Antrobus-Wuth b, Marie-Tinka Uys b, Ilana van Wyk c,
Elisabeth D. Root d, Amanda M. Berrian a,∗
a
Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
b
Kruger to Canyons Biosphere Region, Hoedspruit, Limpopo, South Africa
c
Faculty of Veterinary Science, University of Pretoria, South Africa
d
Institute for Disease Modeling, The Bill & Melinda Gates Foundation, Seattle, Washington, USA

a r t i c l e i n f o a b s t r a c t

Keywords: Improper management of disposable diaper waste is becoming a priority global health issue because it has
WASH resulted in environmental accumulation of fecal pathogens and non-biodegradable material. Concerns include
Waste management drinking water safety, as well as chemical and physical contaminants that may harm human, animal (domestic
Disposable diaper
and wildlife), and environmental health. In rural areas, especially those in low- and middle-income countries
One health
where municipal waste management infrastructure may be lacking, this issue is particularly challenging. Using a
Conservation
Sustainable development goals One Health approach, this study used spatial statistics to describe the location and proximity of disposable diaper
waste sites to livestock grazing areas, human dwellings, rivers, and conservation areas in agro-pastoralist com-
munities in South Africa. A total of 627 unique diaper waste sites were identified and plotted between May 2019
and March 2020. The mean distance of waste sites to rivers was 2,196 m (SD=1,799) and 5,523 m (SD=2,642)
to protected areas. Most diaper waste sites were located along the perimeter of villages and dwellings, where
livestock grazing areas are common. This description of waste sites is an important step in strategizing efficient
and effective waste management programs and policies that prioritize those areas with greatest potential impact
on human, animal, and environmental health for remediation.

1. Introduction these goals aim to build a more sustainable and resilient future for all.
The widespread usage and environmental management of disposable
Sanitation interventions remain a crucial part of public health ini- diapers is a priority global health issue that is related to these SDGs.
tiatives, yet at least 785 million people worldwide lack access to safe, In comparison to their reusable cloth counterparts, disposable diapers
clean, and reliable drinking water, and 673 million people do not have consume more than 20 times the raw materials, produce 60 times the
access to sanitation infrastructure (United Nations, 2019a). In low- and solid waste, and utilize 2.3 times more water (Ajmeri, 2016). Addition-
middle-income countries, diarrheal diseases are the sixth leading cause ally, disposable diapers are comprised largely of superabsorbent poly-
of death (WHO, 2020); however, research shows that reliable access to mers (SAPs), plastics, and wood pulps that contribute to microplastic
sanitation and hygiene interventions such as safe disposal of human exc- pollution (Hasegawa et al., 2021; Niaounakis et al., 2017). The gels and
reta decreases diarrhea-related morbidity (Wolf et al., 2018). The lack polymers that enhance a diaper’s absorbency can take 250–500 years to
of access to basic sanitation and hygiene infrastructure also has nega- degrade (Khoo et al., 2019) and can enhance the water retention prop-
tive social impacts on communities, and women are disproportionately erties of soil (Zekry et al., 2020). Improper waste management can lead
affected (FAO, 2012). to multiple public and environmental health impacts. While research
The United Nations Sustainable Development Goals (SDGs) address is lacking on the long-term health effects associated with exposure to
17 universal health and development issues, including access to clean microplastics, preliminary evidence suggests concern for neurodegen-
water and sanitation (Goal 6) and responsible consumption and produc- erative and autoimmune disorders, cancers, and inflammatory lesions
tion (Goal 12) (United Nations, 2019a). Amidst a growing population, (Prata et al., 2020; Rhaman et al., 2021).

∗
Corresponding author.
E-mail addresses: kordecki.1@osu.edu (H. Kordecki), romy@kruger2canyons.org (R. Antrobus-Wuth), info@kruger2canyons.org (M.-T. Uys),
ilana.vanwyk@up.ac.za (I. van Wyk), elisabeth.root@gatesfoundation.org (E.D. Root), berrian.4@osu.edu (A.M. Berrian).

https://doi.org/10.1016/j.envc.2022.100589
Received 22 April 2022; Received in revised form 20 June 2022; Accepted 19 July 2022
2667-0100/© 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
H. Kordecki, R. Antrobus-Wuth, M.-T. Uys et al. Environmental Challenges 8 (2022) 100589

Human feces are a significant carrier of pathogens and parasites that Table 1
are responsible for numerous infectious diseases, including campylobac- Average distance of diaper waste sites from areas of interest
teriosis, typhoid fever, hepatitis E, cryptosporidiosis, and schistosomi- within the Kruger to Canyons Biosphere Region, Republic of
South Africa.
asis (Huber et al., 1994; Sclar et al., 2016). Many of these pathogens
can contaminate food and water and are considered zoonotic, capa- Area of Interest Mean (meters) SD1 (meters)
ble of being transmitted between humans and animals. Disposable di-
Protected Areas 5523 2642
apers can harbor enteric pathogens that can cause diarrheal diseases Rivers 2196 1799
(Holaday et al., 1995; Huber et al., 1994). Amongst children, these diar-
1
rheal diseases are a major contributor to early childhood death, malnu- SD = standard deviation.
trition, and impaired growth (George et al., 2016). In addition to shared
infectious threats, disposable diapers can also pose a physical hazard for 2.2. Data collection
domestic and wild animals as the polymer materials may damage gas-
trointestinal villi and reduce feed intake (Stock et al., 2020). Ingestion To coordinate and implement K2C sustainable development activi-
of foreign material can also cause intestinal obstructions in animals that ties in accordance with the UNESCO Man and the Biosphere strategy
can be fatal (Ström et al., 2018). (UNESCO, 2021b), the K2C Biosphere Region non-profit organization
Despite the potential harms of disposable diaper waste accumu- was established in 2011. The organization employs residents from com-
lation in the environment, there remains a significant knowledge munities within the Sehlare Tribal Authority through the Environmen-
gap in usage and disposal practices, as well as their environmental tal Monitors (EM) Programme. The EM program is funded through the
fate (Cordella et al., 2015; Martin et al., 1996; Mathe et al., 2018; national Department of Forestry, Fisheries and the Environment, em-
Meseldzija et al., 2013; Reese et al., 2015). As the global population ploying youth to support environmental organizations. From May 2019
grows, understanding the impact of these materials becomes increas- to March 2020, EMs collected the GPS location of disposable diaper
ingly important to safeguard the food and water supply and protect hu- waste sites within selected villages. GPS locations were recorded in a
man and animal health. Waste products generated by human activities Microsoft Excel spreadsheet. Open-source GIS data from the Department
are major causes of environmental and health challenges (Ziraba et al., of Forest, Fisheries and the Environment (Department of Forestry, Fish-
2016). Those most vulnerable to these challenges are those who lack eries and the Environment, 2021), the 2011 Republic of South Africa
municipal infrastructure and reliable access to water, sanitation and hy- National Census (Code for Africa, 2011), and Google EarthTM provided
giene (WASH) resources (Ikeme et al., 2003). Solid waste management additional vector data to describe the relationship of waste sites to hu-
practices vary greatly across regions and even countries and can entail man dwellings, rivers, and protected conservation areas. Protected ar-
reduced waste generation, re-use, recycling, composting, and safe dis- eas were defined as nature reserves, national parks, and protected en-
posal through landfill. In low- and middle-income countries, however, vironments under the National Management Protected Areas Act 2003
these are often not practiced due to lack of laws and policies governing (Department of Forestry, Fisheries and the Environmnent, 2021). The
waste management enforcement and available funding. In low-income decision to utilize nationally recognized protected areas and rivers is
countries, solid waste collection is less than 50% compared to about rooted in the rich dichotomy of terrestrial and aquatic ecosystems. While
98% in high-income countries (Ziraba et al., 2016). vastly different, both of these ecological models provide valuable in-
In South African communities within the Kruger to Canyons (K2C) sights to the types of acute and chronic One Health issues that may
Biosphere Region, identified as a Presidential Poverty Node due to lack result from improper management of disposable diapers.
of access to basic water, sanitation, hygiene, and refuse removal ser-
vices (Bushbuckridge Local Municipality, 2021), environmental accu- 2.3. Data analysis
mulation of disposable diapers has been identified as a priority issue
(Berrian et al., 2016). Prior studies indicate that 80% of households GPS data were imported into and processed using ArcGIS Pro-Version
with young children utilize disposable diapers and disposal practices are 2.7.0. Data input errors were identified and corrected manually. The
variable (e.g., burning, burying, throwing in bush/rivers) (Berrian et al., “XY Table to Point” data management tool was used to create a vector
2016). Due to the ecologically sensitive location of this community at point feature from the coordinates in the dataset. Additional shapefiles
the interface of private and provincial conservation areas, this study from open-source data were added as map layers and results visualized.
aims to quantify and describe the location and proximity of disposable To determine the distance (in meters) between diaper waste sites to
diaper waste sites to livestock grazing areas, human dwellings, rivers, specified areas of interest (e.g., rivers, protected areas), the “Generate
and protected areas. Results may be used to identify priority areas for Near Table” analysis tool was used for calculations. Summary statistics
environmental remediation and inform community waste management were performed to determine the mean and standard deviation asso-
policies and infrastructure. ciated with calculated distances between features. The “Multiple Ring
Buffer” analysis tool was used to describe the density of diaper waste
2. Materials and methods sites around dwellings and grazing areas at 400, 2200 and 4000 m.
Density of sites was used instead of distance from individual dwellings
2.1. Study site because there was not publicly available vector data containing coor-
dinates of individual dwellings within villages. Distances (in meters) of
The study was performed within the Kruger to Canyons (K2C) Bio- specified buffer zones were extrapolated from a voluntary community
sphere Region in northeastern South Africa, which straddles Limpopo survey that asked respondents to report how far they walked to discard
and Mpumalanga Provinces. The biosphere covers over 2.5 million diapers.
hectares, encompassing Kruger National Park and other national and
provincial conservation areas. Three Southern African biomes are in- 3. Results
corporated: grasslands, Afro-montane forests, and the savannah of the
lowveld. This area is also considered a Strategic Water Source Area, gen- A total of 627 unique diaper waste sites were identified and plotted in
erating a disproportionate amount of water for the lower-lying regions relation to rivers (Fig. 1a) and protected areas (Fig. 1b) within the study
(UNESCO, 2021a). There are multiple major towns in the Region (Tza- site. Each waste site location is represented by a single point on the map.
neen, Phalaborwa, Bushbuckridge, Hoedspruit, and Graskop) as well as Average distances of waste sites to areas of interest, including protected
rural villages, which largely consist of agro-pastoralist communities that areas and rivers, are summarized in Table 1. Additionally, three distinct
raise cattle, goats, and chickens predominantly (Berrian et al., 2016). buffer zones were established to determine proportion of waste sites

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H. Kordecki, R. Antrobus-Wuth, M.-T. Uys et al. Environmental Challenges 8 (2022) 100589

Fig. 1. Location of diaper waste sites relative to (a), rivers (blue) and (b), protected areas (green) in the Kruger to Canyons Biosphere Region, Republic of South
Africa.

Table 2 pathogenic bacteria and viruses. When disposed of near drainage, di-
Proportion of diaper waste sites within a specified buffer zone apers can block water runoff, causing flooding. Water accumulation,
within the Kruger to Canyons Biosphere Region, Republic of due to improper drainage or diaper absorption, can also create breed-
South Africa.
ing habitats for insects that transmit disease as biological or mechanical
Buffer Zone (meters) Protected Areas, n (%) Rivers, n (%) vectors (Ntekpe et al., 2020). As an environmental consequence, a study
in Bangladesh demonstrated severe water pollution can significantly di-
<400 13 (2.1) 132 (21.1)
<2200 43 (6.9) 343 (54.7) minish a river’s ability to sustain life by altering vital factors such as
<4000 200 (31.2) 476 (75.9) dissolved oxygen content and pH (Halder and Islam, 2015). While there
is a growing body of literature investigating the health and environmen-
tal impact of water pollution, including but not limited to that caused
within each (Table 2). On average, diaper waste sites were found in by disposable diapers, many of these studies focus on higher density
closer proximity (and in greater proportion) to rivers than protected cities and suburbs with more organized waste management infrastruc-
areas. ture (e.g., landfills, sewer systems). In comparison, the health effects
Google EarthTM allowed for the visualization of diaper waste sites and ecological impacts related to water pollution for more rural com-
in relation to human dwellings and roadways (Fig. 2a). With regard to munities that lack waste and water management systems are not as well
human-dominated landscapes, most diaper waste sites were located on documented. Moreover, the specific topography, climate, and land use
the perimeter of rural villages where dirt roadways and animal grazing in the K2C Region add a layer of complexity to this issue.
areas were common. Most clusters of diaper waste sites in relation to Given the proximity of diaper waste sites to rivers and the signifi-
dwellings and grazing areas were located within the 400-meter buffer cance of surface waters in the K2C to downstream ecosystems, future re-
zone (Fig. 2b). The village of Ga-Boelang had the highest concentration search should focus on water quality, particularly targeting high-density
of diaper waste sites in the study area. waste site locations (e.g., Ga-Boelang). Fecal bacteria, such as total co-
liforms or Escherichia coli, may be useful indicators of water quality as-
4. Discussion sociated with diaper waste. Given the clustering of waste sites on the
perimeter of rural villages (along roadways and animal grazing paths),
The mapping of diaper waste sites in this K2C region allowed for waste management programs, such as the placement of municipal col-
the characterization of disposal practices and the identification of high- lection bins, may target these priority areas. Currently, there is no or-
density clusters that can be prioritized for remediation. Waste sites were ganized or regulated municipal waste management infrastructure in the
aggregated in human-dominated landscapes, particularly adjacent to study area; hence, one of the reasons this region was selected as a Pres-
dwellings and roadways where access by residents and domestic ani- idential Poverty Node.
mals would be greater. With regard to ecologically-sensitive areas, dia- A pilot survey of caretakers in this region revealed that women are
per waste sites were more concentrated near rivers than protected areas. largely responsible for the purchase and disposal of diapers (Kordecki,
Prior survey work in this region suggests that residents perceive rivers as 2021), suggesting an ideal target audience for future education and in-
“washing away” waste and even a potentially environmentally-friendly terventions. Despite the increased cost, all surveyed individuals utilized
disposal option due to the lack of visible accumulation (Kordecki, 2021). disposable diapers to some degree. Reasons behind this are not thor-
A study in Zimbabwe reported that women preferred burning, bury- oughly understood but could be related to convenience, as well as lack
ing, flushing in the toilet, or dumping disposable diapers in open spaces of reliable water accessibility for cleaning reusable diapers. In the future,
Remigios (2014). While less visible to residents, indiscriminate dump- this issue could become exacerbated as climate change threatens fresh-
ing and burying of disposable diapers has the undesirable consequence water availability throughout the world (UNESCO World Water Assess-
of mixing with groundwater and contaminating drinking water with ment Programme, 2020), driving increased use of disposable diapers.

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H. Kordecki, R. Antrobus-Wuth, M.-T. Uys et al. Environmental Challenges 8 (2022) 100589

Fig. 2. Location of (a), diaper waste sites relative to human-dominated landscapes (dwellings, roadways, animal grazing areas) and (b), buffer zones relative to
human-dominated landscapes in the Kruger to Canyons Biosphere Region, Republic of South Africa.

Using demographic data (e.g., number of children per household cur- cumulation and long-term health effects of chronic microplastic expo-
rently using diapers) and estimated number of diapers used per child, sure for both people and animals (domestic and wildlife) that share
the pilot survey also estimated an average of 3.31 (SD=1.66) disposable this landscape. Human feces are well-known carriers of infectious and
diapers used per household per day (Kordecki, 2021). An enhanced un- zoonotic pathogens; however, fecal pollution may not only pose direct
derstanding of purchasing and disposal practices and priorities, includ- health concerns but also drive longer-term risks such as environmental
ing economic, socio-behavioral and cultural factors, may help to guide antimicrobial resistance (AMR) (Thongsamer et al., 2021). Antimicro-
interventions that seek to curb use and/or promote more sustainable bial resistance in E. coli isolates from both people and animals (espe-
disposable practices. Additional research that evaluates these factors in cially food-producing livestock) has shown strong correlation, suggest-
the K2C Region is currently planned. To further improve the current ing transmission across the human-animal interface (Vieira et al., 2011).
study design, future research should also seek to estimate and incorpo- Excessive environmental accumulation of human waste may provide op-
rate the size/scale of diaper waste sites as well as the disposal methods portunities for AMR genes to multiply and introduce novel pathogens
(e.g., bury, burn) as these factors can affect environmental contamina- to threatened and endangered wildlife species. Moreover, immunosup-
tion levels and downstream effects. Additional factors, including terrain pressed or malnourished individuals are especially vulnerable to diar-
slope and seasonal influence (e.g., rainfall), may further affect the con- rheal diseases. Thus, a One Health approach to research and implemen-
tamination pathway and should be considered in future work. tation science is particularly valuable in landscapes such as the K2C Bio-
A limitation of this study was the use of a voluntary community sur- sphere Region where human communities regularly interact with live-
vey (self-report) to determine the distance (in meters) that respondents stock and wildlife.
walked to discard diapers; this measurement was then used to extrapo- While improving access to water, sanitation, hygiene, and waste
late buffer zones in relation to rivers and protected areas. Measurements management services is an important step in mitigating these One
were subject to under-/over-estimation as well as inconsistent units of Health risks, this research also highlights the knowledge gap pertain-
measure that then had to be standardized. Future studies that evalu- ing to the long-term health impacts associated with accumulation of
ate diaper waste site locations should consider incorporating verifiable disposable diapers on a global scale. The global population is expected
measurements, such as GPS waypoints from one location of interest to to rise an additional one billion people by 2030, and sub-Saharan Africa,
another. where public health infrastructure and municipal services often lag, may
One Health issues that may arise from improper management of dis- account for more than half of this growth (United Nations, 2019b). As a
posable diaper waste include fecal contamination and subsequent diar- result, disposable diaper use will likely increase, resulting in the accu-
rheal diseases related to drinking water safety, in addition to the bioac- mulation of environmental waste and pathogen pollution. Future work

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H. Kordecki, R. Antrobus-Wuth, M.-T. Uys et al. Environmental Challenges 8 (2022) 100589

may prove useful in developing effective and sustainable solutions both local communities to collect the data used in this research. The authors
at the community level as well as through manufacturers that may be would like to extend their sincere appreciation for the community mem-
persuaded to provide more environmentally-friendly materials and dis- bers in the region, and their continual support and enthusiasm for re-
posal options that are widely accessible, affordable, and address the re- search that strives to ensure their upliftment and development through
alities of the consumer. innovative scientific initiatives and capacity building.

5. Conclusions References

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