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Author Notes:


J.B. and E.R. conceptualized the review and E.R. acquired sponsorship to support the publication of this research; E.R., S.M.A., J.B., B.D.P. and T.S. participated in the data collection; S.M.A., E.R., J.B., B.D.P. and T.S. analyzed the data and E.R., J.B., S.M.A., B.D.P. and T.S. wrote the original draft; S.M.A., E.R., J.B., B.D.P. and T.S. reviewed and edited the document.

All authors have read and agreed to the published version of the manuscript.

We are grateful to the Centers for Disease Control and Prevention’s (CDC) post graduate fellowship support programs (such as the Oak Ridge Institute for Science and Education Fellowship and the Public Health Associate Program) that enabled us to navigate our way through conducting a rapid literature review. (J.B. and T.S. were post graduate fellows at the CDC through the course of this research).

We are also grateful to the Emory University Library for supporting our review efforts (E.R., S.A. and B.P were postgraduate students at Emory University over the course of this research).

While J.B. has done contract work with the Toilet Board Coalition (cited in the paper) and all authors are affiliated with Wish for WASH Thinks, Inc, the authors declare no conflict of interest.


Research Funding:

The authors received no financial support for the research and authorship.

Emory University is providing support for the publication fees for open access publication of this article.


  • biological sensor.
  • biosensor
  • global health
  • health sensor
  • sanitation
  • sewage
  • toilet
  • wastewater-based epidemiology

Smart sanitation—biosensors as a public health tool in sanitation infrastructure


Journal Title:

International Journal of Environmental Research and Public Health


Volume 17, Number 14


, Pages 1-14

Type of Work:

Article | Final Publisher PDF


The health of individuals and communities is more interconnected than ever, and emergent technologies have the potential to improve public health monitoring at both the community and individual level. A systematic literature review of peer-reviewed and gray literature from 2000-present was conducted on the use of biosensors in sanitation infrastructure (such as toilets, sewage pipes and septic tanks) to assess individual and population health. 21 relevant papers were identified using PubMed, Embase, Global Health, CDC Stacks and NexisUni databases and a reflexive thematic analysis was conducted. Biosensors are being developed for a range of uses including monitoring illicit drug usage in communities, screening for viruses and diagnosing conditions such as diabetes. Most studies were nonrandomized, small-scale pilot or lab studies. Of the sanitation-related biosensors found in the literature, 11 gathered population-level data, seven provided real-time continuous data and 14 were noted to be more cost-effective than traditional surveillance methods. The most commonly discussed strength of these technologies was their ability to conduct rapid, on-site analysis. The findings demonstrate the potential of this emerging technology and the concept of Smart Sanitation to enhance health monitoring at the individual level (for diagnostics) as well as at the community level (for disease surveillance).

Copyright information:

© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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