WHO and UNICEF Position Paper makes reference to SaniPath Exposure Assessment Tool

The WHO and UNICEF position paper Implications of recent WASH and nutrition studies for WASH policy and practice summarized three high-quality studies in the WASH sector that resulted in little or no impact on reducing childhood diarrhea and stunting. The paper aimed to contextualize the findings and distill the implications for future WASH investments.

The report highlighted that oftentimes fecal contamination of produce is not considered when designing and implementing interventions despite prior evidence that this is a dominant exposure pathway in many settings. The paper cites SaniPath as the source of this important piece of evidence.

The evidence generated through SaniPath's work is increasing awareness about this major exposure pathway and contributing to influential position papers such as this one. The data generated from deployments is encouraging policies and practices to address food safety issues that arise from fecal contamination along the value chain.

Use of an evidence based tool to inform action and sanitation investments in Kumasi, Ghana

UNC Water and Health Conference

Presenter: Habib Yakubu

Periodically, resource-challenged municipal governments in urban areas of low-income countries face decisions on how to set priorities for sanitation investments and focus resources for impact. This is primarily due to their lack of knowledge of existing innovative evidence- based sanitation tools. SaniPath exposure assessment tool evaluates the public health risks from poor sanitation and unsafe fecal sludge management in low-income urban areas. It has been deployed in 43 neighborhoods in 9 cities ; Accra, Ghana; Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Dhaka, Bangladesh; Atlanta, United States; Lusaka, Zambia; Kampala, Uganda and Kumasi; Ghana. The most recent shit flows diagram indicates that only an estimated 45% of the fecal sludge is treated. Four neighborhoods of varying geographic and socio economic characteristics were selected for the deployment of the SaniPath tool based on extensive engagement with Kumasi Metropolitan Assembly (KMA). Trained environmental health assistants collected environmental samples and behavior data from multiple pathways in Moshie Zongo, Dakodwom, Fante Newtown and Ahodwo. The nine pathways investigated were; river water, street food, raw produce, drinking water, bathing water, open drain water, soil, public latrines and floodwater. The unit of analysis of the tool is exposure to fecal contamination. Exposure is a measurement of the average amount of E.coli ingested per month (dose) and the percent of the population exposed to fecal contamination per pathway. The most common dominant exposure pathway for children across all the four neighborhoods was open drains. A large percent of the child population was exposed, ranging from 85% to 95% and a high average dose between 10^6 to 10^8 colony forming units (CFU). For adults, the most dominant pathway varied across all the four Page 50 of 56 neighborhoods. Raw produce was the most common dominant pathway in Moshie Zongo, with 78% of the adult population exposed, and a high dose of >10^7. Bathing water was the most dominant pathway in Fante Newtown; with 81% of the population exposed and a high dose of >10^7. Open drains was the most dominant pathway in Ahodwo and Dakodwom with population exposed >61% and high dose values > 10^6. KMA has used this information to take immediate action in two neighborhoods. Firstly, they investigated the source of contamination of a surface water and sanctioned the property owner who had illegally connected directly a shared latrine’s fecal waste into a community river. Secondly, KMA rolled out a school hygiene program to educate primary school students on good hygiene practices within their school compound, in public spaces around open drains and in school toilets. There are other ongoing plans to use the results to inform their sanitation planning, practice and investments. These actions, show that with commitment and access to evidence based sanitation tools, municipal governments in urban areas are capable of using evidence based sanitation tools to prioritize and focus their sanitation investments.

SaniPath Training Hub Evidence to Action

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Using Evidence-Based Decision Making to Guide Sanitation Investments in Low Resource Settings

H Yakubu

39th WEDC Conference (July 2016)

The Center for Global Safe Water, Sanitation, and Hygiene; the Emory University/Water Institute of CSIR/ TREND Group; and the Ministry of Local Government and Rural Development hosted a side event showcasing the experiences of local partners who deployed the SaniPath Tool in Accra, Ghana. This side event delved into the usability of the tool, and the tool’s impact and usage by decision-makers. During the event, interested participants were encouraged to critique the tool and share whether the tool could be applied within their own work. The purpose of the Water, Engineering, and Development Center (WEDC) Conference is to “support knowledge-sharing, develop capacity and improve good practice for the sustainable delivery for water, sanitation, and hygiene services for low- and middle-income countries.”