CGIAR Initiative on One Health

Permanent URI for this collectionhttps://hdl.handle.net/10568/114641

The One Health approach recognizes the interconnections between the health of people, animals, and their shared environment. The One Health Initiative will generate evidence and develop tools enabling the redesign of food systems based on One Health principles, with a focus on reducing human disease risks. More information

Part of the CGIAR Action Area on Resilient Agrifood Systems

Primary CGIAR impact area: Nutrition, health and food security

https://www.cgiar.org/initiative/one-health/

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Using the microbiota to study connectivity at human–animal interfaces
(Journal Article, 2025) Muloi, Dishon M.; Caron, Alexandre; Berkley, J.A.; Hassell, James M.; Brito, I.L.; King, K.; Moodley, Arshnee; Fèvre, Eric M.
Interfaces between humans, livestock, and wildlife, mediated by the environment, are critical points for the transmission and emergence of infectious pathogens and call for leveraging the One Health approach to understanding disease transmission. Current research on pathogen transmission often focuses on single-pathogen systems, providing a limited understanding of the broader microbial interactions occurring at these interfaces. In this review, we make a case for the study of host-associated microbiota for understanding connectivity between host populations at human–animal interfaces. First, we emphasize the need to understand changes in microbiota composition dynamics from interspecies contact. Then, we explore the potential for microbiota monitoring at such interfaces as a predictive tool for infectious disease transmission and as an early-warning system to inform public health interventions. We discuss the methodological challenges and gaps in knowledge in analyzing microbiota composition dynamics, the functional meaning of these changes, and how to establish causality between microbiota changes and health outcomes. We posit that integrating microbiota science with social-ecological systems modeling is essential for advancing our ability to manage health risks and harness opportunities arising from interspecies interactions.
Preventing the next pandemic: One Health researcher calls for urgent action
(Blog Post, 2025-06-03) Hung Nguyen-Viet
CGIAR One Health Initiative to address food system transformation in low- and middle-income countries
(Presentation, 2024-09-23) Hung Nguyen-Viet; Lam, Steven; Hoffmann, Vivian
Factors associated with knowledge, attitudes, and practices of mixed crop-livestock farmers on Crimean Congo hemorrhagic fever (CCHF) and other zoonoses in Burkina Faso
(Journal Article, 2025-06) Ilboudo, Abdoul K.; Dione, Michel M.; Nijhof, A.M.; Groschup, M.H.; Traoré, O.; Ilboudo, Guy S.; Tarnagda, Z.; Savadogo, M.; Bett, Bernard K.
Background: The burden of zoonotic diseases remains high in low and middle-income countries. Among the prevalent zoonoses, Crimean-Congo hemorrhagic fever (CCHF) can pose economic and health threats, particularly among at-risk professionals. We aimed to assess the knowledge, attitudes, and practices regarding CCHF and other zoonoses among mixed-crop livestock farmers in the rural settings of Burkina Faso. Methods: A cross-sectional study that involved selected households from sixteen villages was conducted. Consenting participants aged six and above were randomly included, and a structured questionnaire that collected socio-economic data, knowledge, attitudes, and practices concerning CCHF and other zoonoses was administered. Two index outcome variables were created based on an elaborated scale: i) attitudes and practices at risk of CCHF; and ii) knowledge toward zoonoses. Descriptive statistics were performed, and univariable ordinary least squares (OLS) and seemingly unrelated regression (SUR) were used for univariable and multivariable modeling, respectively, to assess the drivers of both outcomes. Results: Of the 717 respondents, 66.4 % were male, and 20.4 % were under 15 years old. The attitudes and practices at risk were high (48.1 %), and the knowledge toward zoonoses was limited for 47.8 % of the farmers. Our multivariable SUR model shows higher odds of attitudes and practices at risk of CCHF among men (Coef [95 %CI] = 2.85[2.14;3.56]; p-value<0.001). This risk increases with the distance of the livestock grazing area, and among the households owning their livestock grazing area (Coef [95 %CI] = 1.57[0.47;2.66]; p-value = 0.005). The farmer's age (Coef[95 % CI] = 0.02[0.002;0.04]; p-value = 0.028), the male gender (Coef 95 %CI] = 1.5[0.94;2.14]; p-value<0.001), the household's farming surface (Coef[95 %CI] = 0.03[0.002;0.6]; p-value = 0.032), were the significant factors driving knowledge of zoonoses among the farmers. Conclusion: The study reveals a concerning high-risk behavior associated with CCHF among mixed-crop livestock farmers in rural Burkina Faso. The identified socio-demographic drivers underscore the importance of targeted educational and preventive measures to mitigate the impact of CCHF in this vulnerable population.
Antimicrobial resistance in community-acquired enteric pathogens amongst children ≤10-years in low- and middle-income countries: a systematic review and meta-analysis
(Journal Article, 2025-04-28) Okumu, Noah O.; Muloi, Dishon M.; Moodley, Arshnee; Watson, J.; Kiarie, Alice; Ochieng, Linnet; Wasonga, Joseph O.; Mutisya, Christine; Alumasa, Lorren; Ngeranwa, J.J.N.; Cumming, O.; Cook, Elizabeth A.J.
Introduction: Antimicrobial resistance (AMR) is a global health priority. This systematic review summarizes the prevalence of AMR in enteric pathogens originating from the community, specifically among ≤10-year-old children in low-and middle-income countries (LMICs). In addition, it presents the proportions of pooled resistance in Campylobacter spp., Escherichia coli, Shigella spp., and Salmonella spp. (CESS) to clinically relevant antibiotics. Methods: Six online repositories, namely PubMed, Medline, Web of Science, Cochrane Library, CABI, and EMBASE were searched for articles published between January 2005 and September 2024. Random-effects meta-analysis models were constructed to estimate the pooled AMR proportions for CESS pathogens, and a subgroup analysis by region was also carried out. Results: A total of 64 publications from 23 LMICs met our inclusion criteria. The pooled estimates of E. coli AMR for clinically important antibiotics were as follows: sulfamethoxazole/trimethoprim (SXT) 71% [95%CI: 57–82%]; ampicillin (AMP) 56% [95%CI: 44–67%]; ciprofloxacin (CIP) 10% [95%CI: 5–20%]; and ceftriaxone (CRO) 8% [95%CI: 2–31%]. The proportions of AMR detected in Shigella spp. were AMP 76% [95%CI: 60–87%]; nalidixic acid (NA) 9% [95%CI: 2–31%]; CIP 3% [95%CI: 0–15%]; and CRO 2% [95%CI: 0–19%]. The proportions of Salmonella spp. AMR were AMP 55% [95%CI: 35–73%] and SXT 25% [95%CI: 15–38%]. The proportions of Campylobacter spp. AMR were erythromycin (ERY) 33% [95%CI: 12–64%] and CIP 27% [95%CI: 8–61%]. There was high variability in the regional subgroup analysis, with high interstudy and regional heterogeneity I2 ≥ 75%. Conclusion: Our results shed light on drug-resistant enteric bacterial pathogens in young children, providing evidence that CESS pathogens are becoming increasingly resistant to clinically important antimicrobials. Regional differences in resistance patterns between these community isolates highlight the need for strong national and regional surveillance to detect regional variations and inform treatment and appropriate antibiotic stewardship programs. The limitations of our findings include high regional variability, significant interstudy heterogeneity, and underrepresentation of certain LMICs.
Disturbance and disease
(Journal Article, 2025-04-18) Lambin, E.F.; Anugwom, E.; Prist, P.R.; Agha, S.; White, S.; Grace, Delia; Khan, S.A.; Fèvre, Eric M.; Gottdenker, N.; Murray, K.
The world has witnessed an alarming rise in the emergence of infectious diseases, posing profound challenges to public health, ecological balance, and global well-being. Displacement of people and the destabilization of ecosystems create conditions that significantly amplify the risk of disease outbreaks. In this Voices, we ask: how has anthropogenic environmental disturbance impacted the likelihood of disease outbreaks?
Livestock for sustainable food system
(Presentation, 2025-03-15) Unger, Fred; Hung Nguyen-Viet; Baltenweck, Isabelle; Whitbread, Anthony M.; Tarawali, Shirley A.
Biosecurity measures and effects on health performance and antibiotic use in semi-intensive broiler farms in Uganda
(Journal Article, 2025-06) Ayebare, Dreck; Mbatidde, Irene; Kemunto, Naomi P.; Muloi, Dishon M.; Ibayi, Eugine L.; Nielsen, S.S.; Ndoboli, Dickson; Roesel, Kristina; Tenhagen, B.-A.; Moodley, Arshnee
Background: Effective biosecurity measures prevent the spread of pathogens, thereby reducing the need for antibiotic use on livestock farms. However, quantitative data on these practices and health outcomes in semi-intensive broiler farms in low-income settings is limited. A longitudinal study in Wakiso, Uganda, aimed to evaluate biosecurity practices, health performance, and antibiotic use in such farms. Methods: The FarmUSE survey tool was used to collect data from 19 farms over two production cycles. A biosecurity risk assessment tool was used to quantify biosecurity. Blood samples (n = 342) were collected and analyzed using the ProFLOK® assay to assess antibody responses to vaccines for Newcastle disease (NCD), Infectious Bronchitis (IB), and Infectious bursal disease (IBD). Results: Median biosecurity scores were 26.3 % for external measures, 55.6 % for internal measures, and an overall score of 38.5 %. Sixteen farms reported respiratory signs, and 12 had gastrointestinal issues, with median mortality rates of 2.9 % in the first cycle and 4.6 % in the second. Antibiotic use was reported by 84 % and 77 % of farms in the first and second cycles, respectively. The most used antibiotics were tetracyclines, fluoroquinolones, and macrolides, with the highest usage occurring during the brooding phase. Good antibody responses were reported in only 10.5 % of flocks for NCD and 16 % for IBD, while all farms had poor responses against IB. Conclusion: Recurrent clinical signs could be attributed to insufficient biosecurity and inadequate vaccination outcomes, resulting in high antibiotic usage despite low mortality rates. Improving diagnostic access and strengthening the vaccine supply chain are essential. Identifying feasible and cost-effective biosecurity practices for semi-intensive broiler farms can enhance health outcomes, reduce antibiotic use, and boost productivity.
Operationalizing regional One Health initiatives in Southeast Asia: Ways forward
(Journal Article, 2025-06) Lam, Steven; Sinh Dang-Xuan; Unger, Fred; Meeyam, T.; Phuc Pham-Duc; Wacharapluesadee, S.; Hung Nguyen-Viet
Operationalizing One Health initiatives that link human, animal, and environmental health at the regional level is key for jointly addressing infectious diseases that can cross borders. This work is urgently needed in Southeast Asia, a recognized hotspot for emerging animal and human infectious diseases that have the potential to spread globally. As such, our objective is to identify action items to advance regional One Health efforts in Southeast Asia. We organized a 1.5-day workshop that convened 34 experts from government, national research institutes, universities, and international organizations spanning seven countries in Southeast Asia. Group discussions and prioritization exercises were conducted which led to 12 action items, serving as ideas for resourcing, operationalizing, and implementing One Health efforts in Southeast Asia. Participants also emphasized the importance of sustained funding, a collective voice, and a willingness among members to be bold in their collective efforts. Given the heightened focus on zoonotic risks in Southeast Asia, harnessing this momentum by operationalizing regional efforts could establish a solid foundation to draw on when facing future global health threats.
A novel Nobecovirus in an Epomophorus wahlbergi bat from Nairobi, Kenya
(Journal Article, 2025-04-12) VanAcker, M.C.; Ergunay, K.; Webala, P.W.; Kamau, M.; Mutura, J.; Lebunge, R.; Ochola, G.O.; Bourke, B.P.; McDermott, E.G.; Achee, N.L.; Jiang, L.; Grieco, J.P.; Keter, E.; Musanga, A.; Murray, S.; Stabach, J.A.; Craft, M.E.; Fèvre, Eric M.; Linton, Y.-M.; Hassell, James
Most human emerging infectious diseases are zoonotic, originating in animal hosts prior to spillover to humans. Prioritizing the surveillance of wildlife that overlaps with humans and human activities can increase the likelihood of detecting viruses with a high potential for human infection. Here, we obtained fecal swabs from two fruit bat species—Eidolon helvum (n = 6) and Epomophorus wahlbergi (n = 43) (family Pteropodidae)—in peridomestic habitats in Nairobi, Kenya, and used metagenome sequencing to detect microorganisms. A near-complete genome of a novel virus assigned taxonomically to the Coronaviridae family Betacoronavirus genus and Nobecovirus subclade was characterized from E. wahlbergi. Phylogenetic analysis indicates this unique Nobecovirus clade shares a common ancestor with Eidolon/Rousettus Nobecovirus subclades isolated from Madagascar, Kenya, and Cameroon. Recombination was detected across open reading frames, except the spike protein, in all BOOTSCAN analyses, indicating intra-host coinfection and genetic exchange between genome regions. Although Nobecoviruses are currently bat-specific and are not known to be zoonotic, the propensity of coronaviruses to undergo frequent recombination events and the location of the virus alongside high human and livestock densities in one of East Africa’s most rapidly developing cities justifies continued surveillance of animal viruses in high-risk urban landscapes.
CGIAR Research Initiative on One Health: Annual Technical Report 2024
(Report, 2025-04-15) CGIAR Initiative on One Health
Molecular detection and typing of pathogenic Leptospira species from livestock and small mammals in Uganda
(Journal Article, 2025-01-22) Alinaitwe, Lordrick; Wainaina, Martin; Dürr, S.; Kankya, C.; Kivali, Velma; Bugeza, James; Aturinda, C.J.; Lubega, A.; Mayer-Scholl, A.; Hoona, J.J.; Bahn, P.; Hammerl, J.A.; Roesel, Kristina; Cook, Elizabeth A.J.; Richter, M.H.
Leptospira are bacteria that cause leptospirosis in both humans and animals. Human Leptospira infections in Uganda are suspected to arise from animal–human interactions. From a nationwide survey to determine Leptospira prevalence and circulating sequence types in Uganda, we tested 2030 livestock kidney samples, and 117 small mammals (rodents and shrews) using real-time PCR targeting the lipL32 gene. Pathogenic Leptospira species were detected in 45 livestock samples but not in the small mammals. The prevalence was 6.12% in sheep, 4.25% in cattle, 2.08% in goats, and 0.46% in pigs. Sequence typing revealed that Leptospira borgpetersenii, Leptospira kirschneri, and Leptospira interrogans are widespread across Uganda, with 13 novel sequence types identified. These findings enhance the East African MLST database and support the hypothesis that domesticated animals may be a source of human leptospirosis in Uganda, highlighting the need for increased awareness among those in close contact with livestock.
Treatment strategies and antibiotic usage practices in mastitis management in Kenyan smallholder dairy farms
(Journal Article, 2025-03-28) Muloi, Dishon M.; Ibayi, Eugine L.; Nyotera, Sharon; Kirimi, Hildah; Abdi, Abdullahi M.; Mutinda, Silvester M.; Abigael, Chemutai; Moodley, Arshnee
Background: Mastitis is a common driver of antibiotic use in dairy farms and is exacerbated in low-income settings by the lack of diagnostics and treatment strategies. We assessed the decision-making process of animal health providers (AHPs) in managing mastitis in small-holder dairy farms in Kiambu County, Kenya. Data were collected from 114 AHPs and using item response theory, scales were developed to measure attitudes toward udder health, and multivariable linear regression was used to analyse demographic factors associated with these attitudes. Results: Overall, 90% of AHPs diagnose clinical mastitis based on clinical symptoms such as visible udder signs and milk changes, with little diagnostic testing support. Antibiotic treatment was initiated immediately after clinical examination by all, 80% and 50% of AHPs in severe, moderate, and mild mastitis cases, respectively. β-lactams (namely penicillins) and aminoglycosides which were administered mostly parenterally, were the frequently reported antibiotic classes used in treatment of mastitis irrespective of the severity. AHPs with a larger farmer client base and those who did not treat mild mastitis cases with antibiotics had significantly higher mean attitude scores. Treatment of mastitis is primarily based on clinical judgment, with limited microbiological diagnostic support, and parenteral antibiotics are used empirically as first-line therapy. Conclusions: We recommend development of mastitis management support tools such as treatment guidelines and advocate for adoption of routine on-farm rapid testing supported by bacterial culture to guide treatment decision making and antibiotic choice.
Demography of owned dogs across an East African continuum of high-low human density
(Journal Article, 2025-06) Murungi, Maurice K.; Thomas, Lian F.; Bor, Nicholas; Masaku, Ian; Anyango, Mercy; Munywoki, Peterkin N.; Glazer, Camille; Muloi, Dishon M.; Fèvre, Eric M.
Understanding the demographics of domestic dogs is essential for effective disease control strategies, particularly in areas where dogs are key reservoirs of diseases such as rabies. In this study, conducted in a region proximate to Nairobi, Kenya, we aimed to address the lack of current data on dog demographics. This area spans a high-to-low human density continuum, providing a unique setting for examining the relationship between human and dog populations. We used a household (HH) survey approach, stratifying the area by human population density and selecting sub-locations for every 10th percentile of the population density stratum. Households were randomly selected across the strata to estimate the owned dog population, which was then extrapolated to the county level. Additionally, a negative binomial regression model was used to analyse the factors influencing the number of dogs owned by households. We found a human-to-owned dog ratio of 3.3:1, indicating an estimated owned dog population of 421,079 (95% CI: 408,702–424,950) in a county with 1,414,022 humans in the last census, with 65% of the households owning a mean of 2.45 dogs. Multivariable analysis revealed that the presence of a female dog had the strongest association with owning more dogs (OR = 3.08, CI: 2.71 - 3.50). Wealthier households (OR = 1.67, 95% CI: 1.12–2.49), those keeping livestock (OR = 1.67, 95% CI: 1.36–2.02), and larger households (OR = 1.05, 95% CI: 1.03–1.07) were significantly more likely to own more dogs. These findings suggest that actual human-dog ratios may be higher than estimated in sub-Saharan Africa. Accurate dog demographic data is important for dog-mediated disease and conditions control strategies due to its important logistical and financial implications for implementing targeted control initiatives to improve public health and animal welfare.
CGIAR Initiative on One Health results' dissemination workshops in Vietnam
(Report, 2025-01-31) Lam, Steven; Chi Nguyen; Sinh Dang-Xuan; Trang Le; Ha Thi Thanh Nguyen; Hien Thi Thu Nguyen; Thang Nguyen-Tien; Phuong Nguyen; Unger, Fred; Hung Nguyen-Viet
Understanding zoonotic pathogens and risk factors from wildlife in Southeast Asia: a systematic literature review
(Journal Article, 2025-03-10) Ha Thi Thanh Nguyen; Lindahl, Johanna F.; Bett, Bernard K.; Hung Nguyen-Viet; Lam, Steven; Thang Nguyen-Tien; Unger, Fred; Sinh Dang-Xuan; Thanh Xuan Bui; Hien Thanh Le; Lundkvist, Å.; Ling, J.; Hu Suk Lee
The COVID-19 pandemic has demonstrated the significance of the human-animal interface in the emergence of zoonotic diseases, with wildlife serving as an important source of infection. A better understanding of the specific pathogens and mechanisms involved is vital to prepare against future outbreaks, especially in Southeast Asia, a hotspot for zoonotic diseases. This paper reviews the published literature on wildlife zoonoses in this region from 2012 to 2022. The results show a diverse range of potential zoonotic pathogens and the widespread occurrence of zoonotic diseases from wildlife. Drivers of zoonotic pathogen spillover include (i) environmental factors (e.g. animal habitat disruption, environmental conditions, exposure to contaminated water/food/soil), (ii) animal factors (e.g. movement patterns, age-related susceptibility), (iii) human factors (e.g. lack of awareness, poor hygiene practices, age, gender and income) and (iv) human-animal-environmental interface factors (e.g. close contact between humans and animals, exposure through visiting animals and presence of vectors). The diverse drivers of zoonoses in Southeast Asia put its communities at risk for infection. To mitigate these risks, global health efforts should consider adopting a One Health approach to foster collaboration across human, animal, and wildlife health sectors. This could involve educating communities on safe animal interactions and improving disease surveillance.
Advancing waste surveillance through a One Health approach
(Presentation, 2025-02-27) Patel, Ekta; Hung Nguyen-Viet
Multi-mycotoxin occurrence and their risk to poultry health in semi-intensive broiler farms in Kenya
(Journal Article, 2025-05) Njaramba, Jane K.; Muloi, Dishon M.; Velde, M.V.; Saeger, S.D.; Ibayi, Eugine L.; Moodley, Arshnee; Antonissen, G.
Scarcity of feed ingredients, unregulated feed mills, and limited monitoring of mycotoxin levels in feed increase the risk of mycotoxin exposure for poultry in sub-Saharan Africa. This study examined mycotoxins in feed from 122 Kenyan broiler farms and an association between on-farm feed handling practices and mycotoxin levels. Using a validated multi-mycotoxin liquid chromatography-tandem mass spectrometry method (LC-MS/MS), all feed samples contained at least one mycotoxin and 93% (n=113) had >3 mycotoxins. The most prevalent EU-regulated mycotoxins detected were fumonisins (92.6%; 72.7 – 1285.3 μg/kg), deoxynivalenol (88%; 96.6 – 2131.2 μg/kg), aflatoxins (37%; 4.2 – 87.8 μg/kg), and ochratoxin A (4%; range 14.90 – 59.20 μg/kg). Deoxynivalenol, fumonisins, and zearalenone frequently co-occurred in the feed samples. Among the surveyed farms, 33% (n= 40) were at risk of subclinical exposure to deoxynivalenol, while 14% and 7% faced similar risks from total aflatoxins and fumonisins, respectively. Univariate analysis found no significant associations between farm-specific feed handling practices and mycotoxin levels in feed. This study found a high co-occurrence of mycotoxin at low to moderate concentrations in compound broiler feed from the selected farms. While these levels pose a potential risk, no direct link to broiler health outcomes was found. Our findings highlight the need for further research to explore the effects of subclinical mycotoxin exposure on broilers and to develop context-specific mycotoxin level guidelines for the region.
Designing a monitoring plan for microbial water quality and waterborne antimicrobial resistance in the Akaki Catchment, Ethiopia
(Journal Article, 2025-03) Haile, Alemseged Tamiru; Kibret, M.; Haileselassie, M. M.; Anley, K. A.; Bekele, T. W.; Kassa, J. M.; Demissie, Kirubel; Werner, D.; Graham, D.; Mateo-Sagasta, Javier
The Akaki River, in Ethiopia, becomes a source of antimicrobial-resistant (AMR) pathogens and genes that are spreading to receiving water. Water quality monitoring (WQM) is limited in Akaki, and the available evidence is based on short-term monitoring of inconsistent sampling sites and water quality parameters. Therefore, we designed a suitable WQM plan for the Big Akaki River receiving wastewater from rural, urban, and peri-urban areas. WQM plan was designed by employing multiple approaches including literature review, field observations, spatial analysis, and pollutant “hotspot” identification. Information was extracted through a systematic review of 48 articles, selected through a screening process, to guide the selection of suitable monitoring sites. Field observation was used to inspect previously sampled sites and identify pollution sources and exposure routes to antibiotic-resistant bacteria and zoonotic pathogens. For validation, water samples were collected from 40 sites identified from the literature review and field observation, and results were refined during a stakeholder consultation workshop. Hotspots were identified based on chemical oxygen demand, dissolved oxygen, ammonia, and extended-spectrum ßeta-lactamase (ESßL)-producing Escherichia coli and Salmonella enteritidis/Shigella flexneri data. Cluster analysis of the water quality data categorized the 40 sites into three groups, and the number of sites for future monitoring to 20, including possible pollutant hotspots, reference sites, known pollution sources, exposure routes, and availability of river discharge data. The WQM plan will help AMR and zoonotic pathogens monitoring and mitigation in the study sites. Our approach can be replicated to design WQM plans for other rivers.
Performance of four wastewater treatment plants serving Ethiopia’s capital city, Addis Ababa
(Journal Article, 2025-02-01) Haileselassie, M. M.; Mohamed, J.; Haile, Alemseged Tamiru; Hiruy, A. M.; Acharya, K.; Werner, D.
There is an urgent need to expand wastewater treatment on the African continent. To help choose appropriate technologies for this task, we evaluated the efficiency, energy and chemical demands, and costs of four wastewater treatment plants (WWTPs). These plants represent the main wastewater treatment technologies operated by the Addis Ababa Water and Sewerage Authority (AAWSA): waste stabilization pond (WSP), anaerobic baffled reactor (ABR), up-flow anaerobic sludge blanket with trickling filter (UASB-TF), and membrane bioreactor (MBR) technologies. Principal component analysis revealed that season significantly impacts the raw and treated wastewater quality (ANOSIM, R ¼ 0.3126, p ¼ 0.001), while the type of treatment plant did not significantly affect the measured effluent characteristics (ANOSIM, R ¼ 0.1235, p ¼ 0.2000). In contrast, construction and operational costs, as well as energy and chemical demands per m3 of treated wastewater, varied starkly between the WWTPs. Total costs of wastewater treatment in 2022 ranged from $0.045 to 0.546 per m3 of wastewater treated, being 6–12 times higher for MBR compared with the other WWTP technologies. Real-world performance data as reported in this study are essential for choosing appropriate technologies that meet Africa’s wastewater treatment needs.

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