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Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana

Authors: Rebecca Lyn Ritter, Dorothy Peprah, Clair Null, Christine L. Moe, George Armah, Joseph Ampofo, Nii Wellington, Habib Yakubu, Katharine Robb, Amy E. Kirby, Yuke Wang, Katherine Roguski, Heather Reese, Chantal A. Agbemabiese, Lady Asantewa B. Adomako, Matthew C. Freeman, Kelly K. Baker

Abstract: In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered “improved sanitation” because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one’s own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5-12 years and for disposal of feces of children < 5 years, compared with households using public latrines.READ MORE

Assessment of Exposure to Fecal Contamination in Informal Settlements and Formal Neighborhoods of Siem Reap, Cambodia

J. Green, S.Raj, Y.Wang, D. Duong, M. Yakushima, S. Chhun, H. Yakubu, J. Michiel, J. Wicken, CL. Moe

UNC Water and Health Conference (October 2017)

At the 2017 UNC Water and Health Conference in Chapel Hill, North Carolina, Jamie Green presented a poster on an assessment of Exposure to Fecal Contamination in Informal Settlements and Formal Neighborhoods of Siem Reap, Cambodia. The CGSW’s Sanipath Tool was used to assess the risk of exposure to fecal contamination in 5 environmental pathways in 5 neighborhoods (3 formal and 2 informal settlements). Overall, there were large variations in exposure risks within formal neighborhoods and informal settlements. Results show that raw produce posed one of the greatest risks of exposure to fecal contamination across all five neighborhoods (100% of adults exposed to dose ranging from 7.59E05 to 1.78E07 CFU/month from produce). Participants in all neighborhoods reported bottled water and well water as main sources of drinking water, while few reported drinking municipal water. No E. coli was found in municipal water, while bottled water and well water had moderate amount of E. coli. The lowest dose of exposure for floodwater was found in the only neighborhood with a drainage system (4.79E02 CFU/month). Results from this study provide evidence for decision makers to prioritize efforts to reduce exposure to fecal contamination in Siem Reap.

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Public Health Risks Associated with Unsafe Fecal Sludge Management in Accra, Ghana

Habib Yakubu, UNC Water and Health Conference (October 2017)

At the 2017 UNC Water and Health Conference in Chapel Hill, North Carolina, David Berendes and Suraja Raj presented on behalf of Habib Yakubu. Both colleagues discussed the rationale, design, and results of the SaniPath Tool, a tool which evaluates public health risks from unsafe fecal sludge management (FSM) in low resource urban neighborhoods around the world. In this presentation, the results from four representative neighborhoods in Accra, Ghana were shared. The four neighborhoods were classified using a score scale into “very poor”, “poor”, “moderate” and “good” sanitation neighborhoods. Behavior survey and environmental sampling data showed a general trend of fecal exposure that followed the classification of neighborhoods. However, produce had the greatest risk of exposure to fecal contamination regardless of the classification of the neighborhood. Overall the study found that unsafe FSM can lead to exposure to fecal contamination irrespective of where you live.

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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.

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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