Risk of Exposure to Fecal Contamination for Adults and Children in Neighborhoods Across Dhaka, Bangladesh Using the SaniPath Exposure Assessment Tool

S Raj, J Green, Y Wang, N Amin, M Rahman, I Hassan, Z Hassan, G Joseph, CL Moe

UNC Water and Health Conference (October 2018)

At the 2018 UNC Water and Health Conference in Chapel Hill, North Carolina, Suraja Raj presented on a SaniPath Exposure Assessment conducted in 10 neighborhoods (6 low-income 2 mixed-income and 2 high-income) throughout Dhaka between April-June 2017. 1000 environmental samples were collected from shared latrines, public play areas, produce in markets, street food, open drains, flood waters, surface waters, bathing water, municipal water, and non-municipal water. Samples were analyzed using IDEXX-Colilert-24® Quanti-Tray/2000 for most probable number (MPN) of E. coli. Behavior surveys were conducted with households, school children, and community groups to understand interaction with the environment. Using Bayesian methods, these data were used to estimate the percentage of the population exposed and mean dose of fecal exposure (E. coli) for each environmental pathway in each neighborhood. For adults, consumption of raw produce was the dominant exposure pathway (i.e. contributes most to total exposure) in 6 of 10 neighborhoods. 78-99% of adults were exposed to fecal contamination through ingestion of raw produce and the mean dose ranged from 104.8 – 107.5 MPN of E. coli ingested/month. The most common dominant among children (8/10 neighborhoods) was accidental ingestion of drain water from contact with open drains (up to 94% exposed; mean dose of 107.8 MPN of E. coli ingested/month). Ingestion of fecal contamination via produce and street food was a high risk throughout Dhaka while exposure to fecal contamination via municipal drinking water was a greater risk for those living in the south of the city. These results can guide city-wide WASH programming to prioritize interventions and increase the potential for public health impact.

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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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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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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.