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

The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children

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

Abstract: Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. READ MORE

Behavioral influences on risk of exposure to fecal contamination in low-resource neighborhoods in Accra, Ghana

Authors: Jacqueline Hurd, Monique Hennink, Katherine Robb, Clair Null, Dorothy Peprah, Nii Wellington, Habib Yakubu, Christine L. Moe

Abstract: Rapid urbanization in low-resource countries has led to a growing sanitation crisis, with widespread fecal contamination and risk of adverse health outcomes. Understanding how to change sanitation behaviors and reduce exposure to fecal contamination is central to Sustainable Development Goal 6. This study examines behavioral influences on fecal contamination in six low-resource neighborhoods of Accra, Ghana. Qualitative data comprised 12 key informant interviews with community leaders and 16 focus group discussions with residents. Results identify behaviors that increase the presence of feces in urban neighborhoods and risk of exposure to fecal contamination. READ MORE

Quantifying Contact with the Environment: Behaviors of Young Children in Accra, Ghana

Authors: Peter Teunis, Heather Reese, Claire A. Null, Habib Yakubu, Christine L. Moe

Abstract: To better understand the risks of exposure for young children to fecal contamination in their environment, we systematically characterized and quantified behaviors of 154 children, 0-5 years old, in four high-density, low-income neighborhoods in Accra, Ghana. A repertoire of six different activities and five different compartments (categories of locations within the household) was developed, and about 500 hours of ordered structured observations of activities and locations of individual children were collected. READ MORE