The SaniPath Exposure Assessment Tool: A quantitative approach for assessing exposure to fecal contamination through multiple pathways in low resource urban settlements

Raj, Suraja J.; Wang, Yuke; Yakubu, Habib; Robb, Katharine; Siesel, Casey; Green, Jamie; Kirby, Amy; Mairinger, Wolfgang; Michiel, James; Null, Clair; Pérez, Eddy; Roguski, Katherine; Moe, Christine L.

doi:10.1371/journal.pone.0234364

Cited by 33 publications

(47 citation statements)

References 22 publications

(24 reference statements)

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“…The SaniPath tool, an example of such an approach implemented in nine countries to date, combines environmental sample collection and analyses for E. coli with surveys of behavior to estimate exposure. 72 , 175 …”

Section: Methodsmentioning

confidence: 99%

Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group

Goddard

Ban

Barr

et al. 2020

Environ. Sci. Technol.

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Infections with enteric pathogens impose a heavy disease burden, especially among young children in low-income countries. Recent findings from randomized controlled trials of water, sanitation, and hygiene interventions have raised questions about current methods for assessing environmental exposure to enteric pathogens. Approaches for estimating sources and doses of exposure suffer from a number of shortcomings, including reliance on imperfect indicators of fecal contamination instead of actual pathogens and estimating exposure indirectly from imprecise measurements of pathogens in the environment and human interaction therewith. These shortcomings limit the potential for effective surveillance of exposures, identification of important sources and modes of transmission, and evaluation of the effectiveness of interventions. In this review, we summarize current and emerging approaches used to characterize enteric pathogen hazards in different environmental media as well as human interaction with those media (external measures of exposure), and review methods that measure human infection with enteric pathogens as a proxy for past exposure (internal measures of exposure). We draw from lessons learned in other areas of environmental health to highlight how external and internal measures of exposure can be used to more comprehensively assess exposure. We conclude by recommending strategies for advancing enteric pathogen exposure assessments.

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Section: Methodsmentioning

confidence: 99%

Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group

Goddard

Ban

Barr

et al. 2020

Environ. Sci. Technol.

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“…Similarly, there are several public health concerns to which behavior analysts will simply not be able to contribute without collaboration with scientists and professionals in other disciplines. For example, to prevent communicable or infectious diseases that are caused by the spread of microorganisms (e.g., viruses, bacteria, parasites) one must first learn how the pathogen is being spread through human behavior (e.g., Raj et al, 2020). Evaluation of exposure pathways relies heavily on behavioral observation to determine what behaviors result in transmission; behavior analysts could contribute to such evaluations.…”

Section: Collaboratementioning

confidence: 99%

Leveraging applied behavior analysis research and practice in the service of public health

Normand

Dallery

Slanzi

2021

J of App Behav Analysis

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Human behavior plays a central role in all domains of public health. Applied behavior analysis (ABA) research and practice can contribute to public health solutions that directly address human behavior. In this paper, we describe the field of public health, identify points of interaction between public health and ABA, summarize what ABA research has already contributed, and provide several recommendations for how ABA research and practice could continue to promote public health outcomes. A clearer focus on behavior and widespread adoption of research designs and interventions informed by the ABA literature could lead to better public health outcomes. Reciprocally, better integration of public health goals and strategies into ABA research, harnessing of technology, and more collaboration would help diversify and disseminate our applied science and could yield more effective and scalable interventions to prevent and treat public health problems.

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“…Environmental samples were collected from the same sites in the public domain as those collected in the rainy season study [ 22 ]. The SaniPath tool focuses entirely on exposure to faecal contamination in the public domain because they are areas most affected by sanitation interventions, any contamination in the public domain will likely affect the private domain, and also data collection is more practical in the public areas [ 24 ]. Ten samples, which is the minimum recommended number by SaniPath methodology, were collected from each pathway.…”

Section: Methodsmentioning

confidence: 99%

“…The dominant pathway(s) of exposure was determined by multiplying the dose and percentage of the population exposed (both generated by the SaniPath tool), which was then log transformed and denoted as E [ 24 ]. Pathways which have E equal or larger than 10, or which fall within a log 1 range of the maximum E value, are considered high risk and dominant pathways, if the value of E is less than 1 (low risk) for all pathways, then there is no dominant pathways [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Are There Seasonal Variations in Faecal Contamination of Exposure Pathways? An Assessment in a Low–Income Settlement in Uganda

Ronoh

Furlong

Kansiime

et al. 2020

IJERPH

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Sanitation infrastructure are not able to cope with the increasing population in low-income countries, which leaves populations exposed to faecal contamination from multiple pathways. This study evaluated public health risk (using SaniPath) in a low-income community during the dry season, to identify the dominant exposure pathways, and compare this data to existing data for the rainy season, questioning the assumption that risk of faecal contamination is higher in the rainy season. SaniPath was used to collect and assess exposure and environmental data, and to generate risk profiles for each pathway. In the dry season the highest exposure frequency was for bathing and street food, exposure frequency generally increased, and seasonal variation was found in five pathways. The highest hazards in the dry season were through contact with drains, soil, and street food. Seasonal variation was found in the contamination of open drains and street food, with higher levels of Escherichia coli (E. coli) in the dry season. Open drains were identified as the most dominant risk pathway in both seasons, but risk was higher in the dry season. This highlights the complex nature of seasonal variation of faecal risk, and questions the assumption that risk is higher in the rainy season.

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The SaniPath Exposure Assessment Tool: A quantitative approach for assessing exposure to fecal contamination through multiple pathways in low resource urban settlements

Abstract: Tool has been deployed in nine cities to date, and the results are being used by local authorities to design and prioritize programming and policy. The SaniPath Tool is a novel approach to support public-health evidence-based decision-making for urban sanitation policies and investments.

Cited by 33 publications

References 22 publications

Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group

Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group

Leveraging applied behavior analysis research and practice in the service of public health

Are There Seasonal Variations in Faecal Contamination of Exposure Pathways? An Assessment in a Low–Income Settlement in Uganda

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