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Pathogen flows: Applying public health principles to urban sanitation – A synthesis of current research, tools and approaches that add the public health perspective back into urban sanitation

CL Moe

World Water Week (August 2017)

At the 2017 World Water Week conference in Stockholm, Sweden, Dr. Christine Moe participated in a presentation that examined the intersection of urban sanitation and public health. Dr. Moe explained the rationale, design, and results of the SaniPath Tool and how public health principles are incorporated to assess risk of exposure to fecal contamination in urban low-income communities. The presentation discussed the value of incorporating public health principles in sanitation tools and how results can be used to influence policy. This event covered “solid and liquid fecal wastes, in sewered and unsewered settings” and aimed to focus on how pathogen flow factors could be incorporated into sanitation action and thinking.

Access presentation here

Multipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach

Authors: Yuke Wang, Christine L. Moe, Clair Null, Suraja J. Raj, Kelly K. Baker, Katharine A. Robb, Habib Yakubu, Joseph A. Ampofo, Nii Wellington, Matthew C. Freeman, George Armah, Heather E. Reese, Dorothy Peprah, Peter F. M. Teunis

Abstract: Lack of adequate sanitation results in fecal contamination of the environment and poses a risk of disease transmission via multiple exposure pathways. To better understand how eight different sources contribute to overall exposure to fecal contamination, we quantified exposure through multiple pathways for children under 5 years old in four high-density, low-income, urban neighborhoods in Accra, Ghana. We collected more than 500 hours of structured observation of behaviors of 156 children, 800 household surveys, and 1,855 environmental samples. Data were analyzed using Bayesian models, estimating the environmental and behavioral factors associated with exposure to fecal contamination. READ MORE

Translating Sanitation Tool Results to Policy

Emory University, TREND Group, Ghana, Center for Science and Environment (CSE), India, Center for Study of Science, Technology and Policy (CSTEP)

40th WEDC International Conference (July 2017) – Side Event

At the 40th WEDC conference in Loughborough, UK, Habib Yakubu and Christine Moe of the SaniPath team hosted a side event with CSE, CSTEP, and TREND that allowed for sharing of experiences related to using sanitation-related tools and data to influence policy and development. The outcome was an engaging discussion about how to best use tools to influence policy by engaging policymakers and by considering how results of tools can inform evidence-based policy recommendations.

Assessment of Fecal Exposure Pathways in Low-Income Urban Neighborhoods in Accra, Ghana: Rationale, Design, Methods, and Key Findings of the SaniPath Study

Authors: Katharine Robb, Clair A. Null, Peter Teunis, Habib Yakubu, George Armah, Christine L. Moe

Abstract: Rapid urbanization has contributed to an urban sanitation crisis in low-income countries. Residents in low-income, urban neighborhoods often have poor sanitation infrastructure and services and may experience frequent exposure to fecal contamination through a range of pathways. There are little data to prioritize strategies to decrease exposure to fecal contamination in these complex and highly contaminated environments, and public health priorities are rarely considered when planning urban sanitation investments. The SaniPath Study addresses this need by characterizing pathways of exposure to fecal contamination. Over a 16-month period, an in-depth, interdisciplinary exposure assessment was conducted in both public and private domains of four neighborhoods in Accra, Ghana.READ MORE

Household sanitation is associated with lower risk of bacterial and protozoal enteric infections, but not viral infections and diarrhoea, in a cohort study in a low-income urban neighbourhood in Vellore, India

Authors: David Berendes, Juan Leon, Amy Kirby, Julie Clennon, Suraja Raj, Habib Yakubu, Katharine Robb, Arun Kartikeyan, Priya Hemavathy, Annai Gunasekaran, Sheela Roy, Ben Chirag Ghale, J. Senthil Kumar, Venkata Raghava Mohan, Gagandeep Kang, Christine L. Moe

Abstract: Objective: This study examined associations between household sanitation and enteric infection – including diarrhoeal-specific outcomes – in children 0–2 years of age in a low-income, dense urban neighbourhood.

Methods: As part of the MAL-ED study, 230 children in a low-income, urban, Indian neighbourhood provided stool specimens at 14–17 scheduled time points and during diarrhoeal episodes in the first 2 years of life that were analysed for bacterial, parasitic (protozoa and helminths) and viral pathogens. From interviews with caregivers in 100 households, the relationship between the presence (and discharge) of household sanitation facilities and any, pathogen-specific, and diarrhoea-specific enteric infection was tested through mixed-effects Poisson regression models.READ MORE