Urban sanitation coverage and environmental fecal contamination: Links between the household and public environments of Accra, Ghana

Abstract

Exposure to fecal contamination in public areas, especially in dense, urban environments, may significantly contribute to enteric infection risk. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Soil (n = 72) and open drain (n = 90) samples were tested for E. coli, adenovirus, and norovirus. Sanitation facilities in surveyed households (n = 793) were categorized by onsite fecal sludge containment (“contained” vs. “uncontained”) using previous Joint Monitoring Program infrastructure guidelines. Most sanitation facilities were shared by multiple households. Associations between spatial clustering of household sanitation coverage and fecal contamination were examined, controlling for neighborhood and population density (measured as enumeration areas in the 2010 census and spatially matched to sample locations). E. coli concentrations in drains within 50m of clusters of contained household sanitation were more than 3 log-units lower than those outside of clusters. Further, although results were not always statistically significant, E. coli concentrations in drains showed consistent trends with household sanitation coverage clusters: concentrations were lower in or near clusters of high coverage of household sanitation facilities—especially contained facilities—and vice versa. Virus detection in drains and E. coli concentrations in soil were not significantly associated with clustering of any type of household sanitation and did not exhibit consistent trends. Population density alone was not significantly associated with any of the fecal contamination outcomes by itself and was a significant, yet inconsistent, effect modifier of the association between sanitation clusters and E. coli concentrations. These findings suggest clustering of contained household sanitation, even when shared, may be associated with lower levels of fecal contamination within drains in the immediate public domain. Further research is needed to better quantify these relationships and examine impacts on health.

Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial

“…Each visit had a window to enable follow-up if the infant was not seen on the target date. Environmental enteric dysfunction in Zimbabwean children in WASH coverage are associated with reductions in environmental faecal contamination [83]. In addition, exposure to animal rather than human excreta may represent a larger source of faecal contamination [84].…”

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

“…Other activities such as discharge of faecal waste during the rainy season can also lead to the contamination of soil. A study in an urban slum in Uganda found higher levels of E. coli (5.4 log10 CFU per g), compared to this study during the dry season, but there, samples were taken specifically from open spaces and the playgrounds of children [ 33 ]. Children face considerable risk from soil during the dry season, this is because they spend most of the time playing outside on the ground.…”

“…This seasonal variation was found to be significantly different ( p ≤ 0.05, Table 2 ). The only other study that explored seasonal variation in E. coli concentration in open drains was from Ghana, though they did not find any variations, and the study looked at two rainy seasons [ 33 ]. The results are surprising because it would have been expected that the risk would have been higher during the rainy season than the dry season because it has been observed that most elevated latrines in Kampala have an opening at the back which is used to empty faecal sludge into adjacent open drains, in addition to the washing effect of rain [ 30 ]…”

“…Spring water was used by a minority of respondents for bathing (32% during the rainy season [ 22 ] and 22% during the dry season), and was analyzed for E. coli contamination ( Table 2 ). The contamination of unprotected springs during the dry season is similar to a QMRA in Kampala (2.5 log10 CFU per 100 mL) [ 33 ]. The geometric mean concentration level of E. coli in springs in the rainy season was slightly lower compared to the dry season ( Table 2 ).…”

Diarrea persistente en la población infantil

“…La exposición a la contaminación fecal en áreas públicas, especialmente en entornos urbanos densos, puede contribuir significativamente al riesgo de infección entérica. Berendes et al (2018) examinaron las asociaciones entre el saneamiento y la contaminación fecal en entornos públicos en cuatro barrios de bajos ingresos en Ghana. Los autores hallaron una mayor concentración de microorganismos fecales en áreas con escasa infraestructura sanitaria.…”