Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh

Abstract

Enteric pathogens can be transmitted within the household and the surrounding neighborhood. The objective of this study was to understand the effect of neighborhood-level sanitation coverage on contamination of the household environment with levels of fecal indicator bacteria in rural Bangladesh. We conducted spot-check observations of sanitation facilities in neighboring households (NHs) within a 20-m radius of target households with children aged 6-24 months. Sanitation facilities were defined as improved (a private pit latrine with a slab or better) or unimproved. Fecal coliforms (FCs) on children's hands and sentinel toy balls were measured and used as indicators of household-level fecal contamination. We visited 1,784 NHs surrounding 428 target households. On average, sentinel toy balls had 2.11 (standard deviation [SD] = 1.37) log 10 colony-forming units (CFUs) of FCs/toy ball and children's hands had 2.23 (SD = 1.15) log 10 CFU of FCs/two hands. Access to 100% private improved sanitation coverage in the neighborhood was associated with a small and statistically insignificant difference in contamination of sentinel toy balls (difference in means = −0.13 log 10 CFU/toy ball; 95% confidence intervals [CI]: −0.64, 0.39; P = 0.63) and children's hands (difference in means = −0.11 log 10 CFU/two hands; 95% CI: −0.53, 0.32; P = 0.62). Improved sanitation coverage in the neighborhood had limited measurable effect on FCs in the target household environment. Other factors such as access to improved sanitation in the household, absence of cow dung, presence of appropriate water drainage, and optimal handwashing practice may be more important in reducing FCs in the household environment.

Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique

“…Many have speculated that sanitation’s apparent lack of effect may be due in part to animal fecal contamination. , Animal feces often contain pathogens capable of infecting humans and animal fecal biomass in domestic environments is estimated to far exceed that from humans. ,− Inadequate management of child feces and fecal sludge, contamination of food and water outside the home, and inadequate community-level drainage, solid waste, and sanitation services all present potential pathways of continued contamination despite household sanitation improvements. ,− Recognizing calls for “transformative” WASH to address these multifarious hazards, sustained progress may require high standards of housing and public services in addition to WASH improvements, necessitating multisectoral coordination and financing. ,− Even small treatment effects may translate to positive economic benefits . Additionally, quality sanitation infrastructure can provide important benefits irrespective of preventing pathogen exposure, particularly in crowded urban settlements. , For example, previous research found users of MapSan intervention latrines and similar facilities in the same neighborhoods reported reduced disgust and embarrassment about unhygienic conditions and improved perceptions of security and privacy .…”

A localized sanitation status index as a proxy for fecal contamination in urban Maputo, Mozambique

“…coli on surfaces. Exclusively swabbing horizontal surfaces such as floors [18], or identical sentinel objects such as a child’s play toy, may be better approaches to standardize swab surfaces among households [19,72,73].…”

Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea

“…Young children frequently place their hands in their mouths, and in Bangladesh, it is also common to eat and to be fed by hand [ 18 ]. Previous studies in Bangladesh demonstrated that caregiver’s and children’s hands can contain fecal indicator organisms at concentrations of >100 colony forming units (CFU) per two hands [ 19 ]. The presence of child feces in the household environment could be a potential contributor to fecal contamination of hands in this setting.…”