The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children

• Type of Material: Article
• Authors: David Berendes, Georgia Institute of Technology; Amy Kirby, Emory University; Julie Clennon, Emory University; Suraja Raj, Rollins School of Public Health; Habib Yakubu, Rollins School of Public Health; Juan Leon, Emory University; Katharine Robb, Rollins School of Public Health; Arun Kartikeyan, Christian Medical College; Priya Hemavathy, Christian Medical College; Annai Gunasekaran, Christian Medical College; Ben Ghale, Christian Medical College; J. Senthil Kumar, Christian Medical College; Venkata Raghava Mohan, Christian Medical College; Gagandeep Kang, Christian Medical College; Christine Moe, Emory University
• Language: English
• Date: 2017-03-20
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: Copyright ©The American Society of Tropical Medicine and Hygiene
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.16-0170
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Grant/Funding Information: This study was funded by the Bill and Melinda Gates Foundation.; The funders had no role in the design or implementation of this study
• Research Categories: Health Sciences, Public Health; Environmental Sciences

Abstract

Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. The two neighborhoods differed significantly in toilet coverage (78% versus 33%) and spatial clustering. Overall, 49% of toilets discharged directly into open drains (“poor FSM”). Children in households with poor FSM had 3.78 times higher prevalence of enteric infection when compared with children in other households, even those without toilets. In the neighborhood with high coverage of household toilets, children in households with poor FSM had 10 times higher prevalence of enteric infection than other children in the neighborhood and drains in poor FSM clusters who had significantly higher concentrations of genogroup II norovirus. Conversely, children in households with a toilet that contained excreta in a tank onsite had 55% lower prevalence of enteric infection compared with the rest of the study area. Notably, households with a toilet in the neighborhood with low toilet coverage had more fecal contamination on floors where children played compared with those without a toilet. Overall, both toilet coverage levels and FSM were associated with environmental fecal contamination and, subsequently, enteric infection prevalence in this urban setting.