The City of St. Louis is located within the state of Missouri, USA. Built along the Mississippi River, it borders St. Louis County but is not a part of it. The Metropolitan St. Louis Sewer District (MSD) serves the City of St. Louis and 90% of St. Louis County, equivalent to a total of 1.3 million people. It is estimated that 90% of fecal sludge and wastewater is treated and safely managed, while the 10% that is not treated is discharged from Combined Sewer Overflows and Sanitary Sewer Overflows.

• Prepared by: The Bill & Melinda Gates Foundation
• Last update: 09/02/2023