Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh

• Type of Material: Article
• Authors: Ayse Ercumen, North Carolina State University; Amy J. Pickering, Tufts University; Laura H. Kwong, Stanford University; Andrew Mertens, University of California Berkeley; Benjamin F. Arnold, University of California Berkeley; Jade Benjamin-Chung, University of California Berkeley; Alan E. Hubbard, University of California Berkeley; Mahfuja Alam, International Centre for Diarrhoeal Disease Research; Debashis Sen, International Centre for Diarrhoeal Disease Research; Sharmin Islam, International Centre for Diarrhoeal Disease Research; Md. Zahidur Rahman, International Centre for Diarrhoeal Disease Research; Craig Kullmann, The World Bank; Claire Chase, The World Bank; Rokeya Ahmed, The World Bank; Sarker Masud Parvez, International Centre for Diarrhoeal Disease Research; Leanne Unicomb, International Centre for Diarrhoeal Disease Research; Mahbubur Rahman, International Centre for Diarrhoeal Disease Research; Pavani K. Ram, University of Buffalo; Thomas Clasen, Emory University; Stephen P. Luby, Stanford University; John M. Colford, University of California Berkeley
• Language: English
• Date: 2018-11-06
• Publisher: American Chemical Society
• Publication Version: Final Published Version
• Copyright Statement: © 2018 American Chemical Society.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1021/acs.est.8b02988
• Title of Journal or Parent Work: Environmental Science and Technology
• ISSN: 0013-936X
• Volume: 52
• Issue: 21
• Start Page: 12089
• End Page: 12097
• Grant/Funding Information: icddr,b acknowledges with gratitude the commitment of Bill & Melinda Gates Foundation and University of California, Berkeley to its research efforts.; icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support.; This research protocol was funded by the World Bank and by Global Development grant OPPGD759 from Bill & Melinda Gates Foundation to University of California, Berkeley to International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b, grant number 741).
• Keywords: TRANSMISSION; INTERVENTIONS; ESCHERICHIA-COLI; Environmental Sciences & Ecology; Engineering, Environmental; GROUNDWATER; Technology; Engineering; CHILD GROWTH; IMPACT; QUALITY; DRINKING-WATER; Environmental Sciences; HOUSEHOLDS; Science & Technology; DIARRHEA; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health; Engineering, Environmental

Abstract

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial's control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog10 = -0.88 (-1.01, -0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.