Assessment of Public Health Risks from 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

4th International Faecal Sludge Management Conference (February 2017)

Habib Yukubu shared the results of a deployment of the SaniPath tool in Accra, Ghana during the 4th International Faecal Sludge Management Conference. The purpose of the study was to evaluate whether the tool could be used to characterize city level exposure to fecal contamination using a subset of representative neighborhoods with varying sanitation coverage, population density, and socioeconomic status. Yukubu and his colleagues found that the SaniPath could be a useful tool to determine which exposure pathway presents the greatest risk of exposure to fecal contamination and whether that risk differed between neighborhoods.

In the study, Yukubu and his colleagues conducted behavioral surveys and collected sample data in four representative Accra, Ghana neighborhoods between April and August 2016. Each neighborhood varied as to its’ level of sanitation coverage, population density, and socioeconomic status, according to the Ghana Statistical Service 2010 census and the Accra Metropolitan Authority Poverty Map.

After collecting and analyzing the data, the researchers found that the produce pathway had the greatest risk of exposure to fecal contamination, and that the proportion of people exposed to fecal contamination via produce ranged from 93%-96% across each neighborhood. By combining behavioral data and environmental exposure data, the pathway posing the greatest threat to individuals became clear. Given this information from the SaniPath tool, decision makers have solid evidence to help plan and prioritize sanitation investments in resource poor settings.

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The Role of Toilets, FSM, and Flooding on Enteric Infection in Children in Vellore, India

D Berendes, J Leon, A Kirby, J Clennon, S Raj, H Yakubu, K Robb, A Kartikeyan, P Hemavathy, A Gunasekaran, S Roy, B Ghale, J Kumar, V Mohan, G Kang, CL Moe

4th International Faecal Sludge Management Conference (February 2017)

During the 4th International Faecal Sludge Management Conference, David Berendes presented the findings from a study that examined household and neighborhood environmental factors which contribute to pediatric enteric infection risk. The key lessons learned from this study are: it is imperative that homes with tanks that discharge directly to open drains plan for fecal sludge containment during rainy seasons, and that low coverage of household toilets combined with prevalent open drains may increase the risk of enteric infection among children.

This five-year study conducted within a single, low-income, urban neighborhood in India looked at whether the presence of household toilets, the type of fecal sludge management associated with a toilet (e.g. toilets discharging to an open drain versus ones containing feces onsite), and the presence of flooding in the neighborhood influenced the risk that a young infant will acquire an enteric disease.

To do this, the researchers collected and tested stool samples, assessed spatial data, and conducted household caregiver interviews. After collecting and testing diarrheal and monthly stool samples from 230 children for enteric pathogens, and examining 100 household caregiver interviews, they found that 82% of the 33% of households that had a toilet had toilets that discharged to open drains. Although the presence of a toilet that discharged to an open drain reduced the risk of enteric infection during the dry season, Berendes and his colleagues discovered that this protective effect vanished during the monsoon season. They also found that drain flooding was associated with significantly higher risk of infection during the monsoon season, and that low toilet coverage within a neighborhood can create downstream negative effects. Given these results, planners should be wary of the setup of toilets to ensure that the benefits of toilets are not nullified due to flooding.

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Fecal Exposure Assessment of Young Children in Crowded, Low-Income Neighborhood in Accra, Ghana

Y Wang, CL Moe, C Null, S Raj, K Baker, K Robb, H Yakubu, J Ampofo, N Wellington, M Freeman, G Armah, H Reese, D Peprah, P Teunis

American Society of Tropical Medicine and Hygiene (November 2016)

Yuke Wang presented a poster that discussed quantitative analysis results related to a SaniPath deployment in low-income urban environments in Accra, Ghana. This presentation included discussions related to the fecal microbe transfer network designed based on structured observations, questionnaires, and environmental samples. The analysis technique allowed for tracking of fecal bacteria from the environment to oral ingestion by utilizing fecal microbe transfer networks and provides insight as to risk of exposure to fecal microbes across various exposure pathways. This presentation was given at the 2016 ASTMH meeting in Atlanta, GA, which brings together professionals interested in tropical medicine and global health.

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