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Children Are Exposed to Fecal Contamination via Multiple Interconnected Pathways: A Network Model for Exposure Assessment

Authors: Yuke Wang, Christine L. Moe, Peter F. M. Teunis

Abstract: In recent decades, quantitative microbial risk assessment (QMRA) has been widely used to assess exposure to fecal microbes and associated health risks. In this study, a multipathway exposure assessment model was developed to evaluate exposure to fecal microbes for children under 5 in highly contaminated urban environments. Children had contact with various environmental compartments. The contamination levels of these compartments were estimated from fecal indicator counts in the environmental samples. Structured observations of child behavior (including activities, locations, and time) were used to model behavioral sequences as a dynamic network. The exposure model combines behavior sequences with environmental contamination, using additional exposure factors when needed, to estimate the number of fecal microbes transferred from environmental sources to human oral ingestion. As fecal exposure in a highly contaminated urban environment consists of contributions from multiple pathways, it is imperative to study their relative importance. READ MORE

Urban sanitation coverage and environmental fecal contamination: Links between the household and public environments of Accra, Ghana

Authors: David M. Berendes, Amy E. Kirby, Julie A. Clennon, Chantal Agbemabiese, Joseph A. Ampofo, George E. Armah, Kelly K. Baker, Pengbo Liu, Heather E. Reese, Katharine A. Robb, Nii Wellington, Habib Yakubu, Christine L. Moe

Abstract: Exposure to fecal contamination in public areas, especially in dense, urban environments, may significantly contribute to enteric infection risk. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Soil (n = 72) and open drain (n = 90) samples were tested for E. coli, adenovirus, and norovirus. Sanitation facilities in surveyed households (n = 793) were categorized by onsite fecal sludge containment (“contained” vs. “uncontained”) using previous Joint Monitoring Program infrastructure guidelines. Most sanitation facilities were shared by multiple households. READ MORE

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

H Yakubu, D Berendes, K Robb, A Kirby, Y Wang, J Michiel, B Doe, S Raj, J Ampofo, CL Moe

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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