About this item:

458 Views | 1,139 Downloads

Author Notes:

Address correspondence to David Berendes, Department of Environmental Engineering, School of Civil and Environmental Engineering, Georgia Institute of Technology, Ford ES<T 3368, 311 Ferst Dr., Atlanta, GA 30332-0002. E-mail: david.berendes@ce.gatech.edu

We would like to thank the field and lab staff at CMC in Vellore, including Sheela Roy and field teams, for their effort on this study and all aspects of the SaniPath study in Vellore, India.

Further, we would like to thank the Bill < Melinda Gates Foundation for funding this study and the two anonymous reviewers for their careful commentary and suggestions that greatly improved this manuscript.

See publication for full list of authors' addresses.


Research Funding:

This study was funded by the Bill and Melinda Gates Foundation.

The funders had no role in the design or implementation of this study

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

Show all authors Show less authors


Journal Title:

American Journal of Tropical Medicine and Hygiene


Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

Copyright ©The American Society of Tropical Medicine and Hygiene

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Export to EndNote