1921
Volume 96, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Prüss A, Kay D, Fewtrell L, Bartram J, , 2002. Estimating the burden of disease from water, sanitation and hygiene at a global level. Environ Health Perspect 110: 537542.[Crossref] [Google Scholar]
  2. Mbuya MNN, Humphrey JH, , 2016. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr 12 (Suppl 1): 106120.[Crossref] [Google Scholar]
  3. UNICEF and World Health Organization, 2012. Progress on Drinking Water and Sanitation: 2012 Update. New York: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. [Google Scholar]
  4. Alirol E, Getaz L, Stoll B, Chappuis F, Loutan L, , 2011. Urbanisation and infectious diseases in a globalised world. Lancet Infect Dis 11: 131141.[Crossref] [Google Scholar]
  5. Mara D, Lane J, Scott B, Trouba D, , 2010. Sanitation and health. PLoS Med 7: e1000363.[Crossref] [Google Scholar]
  6. Baum R, Luh J, Bartram J, , 2013. Sanitation: a global estimate of sewerage connections without treatment and the resulting impact on MDG progress. Environ Sci Technol 47: 19942000.[Crossref] [Google Scholar]
  7. Peal A, Evans B, Blackett I, Hawkins P, Heymans C, , 2014. Fecal sludge management: a comparative analysis of 12 cities. J Water Sanit Hyg Dev 4: 563575.[Crossref] [Google Scholar]
  8. Isunju JB, Schwartz K, Schouten MA, Johnson WP, van Dijk MP, , 2011. Socio-economic aspects of improved sanitation in slums: a review. Public Health 125: 368376.[Crossref] [Google Scholar]
  9. Victora CG, Smith PG, Vaughan JP, Nobre LC, Lombardi C, Teixeira AM, Fuchs SC, Moreira LB, Gigante LP, Barros FC, , 1988. Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea. Int J Epidemiol 17: 651654. http://www.ncbi.nlm.nih.gov/pubmed/3209344.[Crossref] [Google Scholar]
  10. D'Souza RMD, , 1997. Housing and environmental factors and their effects on the health of children in the slums of Karachi, Pakistan. J Biosoc Sci 29: 271281.[Crossref] [Google Scholar]
  11. Katukiza AY, Ronteltap M, Niwagaba CB, Foppen JWA, Kansiime F, Lens PNL, , 2012. Sustainable sanitation technology options for urban slums. Biotechnol Adv 30: 964978.[Crossref] [Google Scholar]
  12. Clasen T, Bostoen K, Schmidt W, Boisson S, Fung I, Jenkins M, Scott B, Sugden S, Cairncross S, , 2010. Interventions to improve disposal of human excreta for preventing diarrhoea (review). Cochrane Database Syst Rev CD007180. [Google Scholar]
  13. Wolf J, Prüss-Ustün A, Cumming O, Bartram J, Bonjour S, Cairncross S, Clasen T, Colford JM, Curtis V, De France J, Fewtrell L, Freeman MC, Gordon B, Hunter PR, Jeandron A, Johnston RB, Mäusezahl D, Mathers C, Neira M, Higgins JPT, , 2014. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Trop Med Int Health 19: 928942.[Crossref] [Google Scholar]
  14. Labite H, Lunani I, van der Steen P, Vairavamoorthy K, Drechsel P, Lens P, , 2010. Quantitative microbial risk analysis to evaluate health effects of interventions in the urban water system of Accra, Ghana. J Water Health 8: 417430.[Crossref] [Google Scholar]
  15. Katukiza AY, Ronteltap M, van der Steen P, Foppen JWA, Lens PNL, , 2014. Quantification of microbial risks to human health caused by waterborne viruses and bacteria in an urban slum. J Appl Microbiol 116: 447463.[Crossref] [Google Scholar]
  16. Wagner EG, Lanoix JN, , 1958. Excreta Disposal for Rural Areas and Small Communities. Geneva, Switzerland: WHO. [Google Scholar]
  17. Peal A, Evans B, Blackett I, Hawkins P, Heymans C, , 2014. Fecal sludge management (FSM): analytical tools for assessing FSM in cities. J Water Sanit Hyg Dev 4: 371.[Crossref] [Google Scholar]
  18. Strande L, Ronteltap M, Brdjanovic D, (eds.), 2014. Faecal Sludge Management: Systems Approach for Implementation and Operation. London, United Kingdom: IWA Publishing. [Google Scholar]
  19. Norman G, Pedley S, Takkouche B, , 2010. Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis. Lancet Infect Dis 10: 536544.[Crossref] [Google Scholar]
  20. Shuval HI, Tilden RL, Perry BH, Grosse RN, , 1981. Effect of investments in water supply and sanitation. Bull World Health Organ 59: 243248. [Google Scholar]
  21. Bateman OM, Smith S, , 1991. A Comparison of the Health Effects of Water Supply and Sanitation in Urban and Rural Guatemala. Washington, DC: United States Agency for International Development. [Google Scholar]
  22. Root GPM, , 2001. Sanitation, community environments, and childhood diarrhea in rural Zimbabwe. J Health Popul Nutr 19: 7382. [Google Scholar]
  23. Eisenberg JNS, Trostle J, Sorensen RJD, Shields KF, . Toward a systems approach to enteric pathogen transmission: from individual independence to community interdependence. Annu Rev Public Heal 33: 239257.[Crossref] [Google Scholar]
  24. Emory University, 2014. SaniPath. Available at: www.sanipath.org. Accessed November 21, 2015.
  25. John SM, Thomas RJ, Kaki S, Sharma SL, Ramanujam K, Raghava MV, Koshy B, Bose A, Rose A, Rose W, Ramachandran A, Joseph AJ, Babji S, Kang G, , 2014. Establishment of the MAL-ED birth cohort study site in Vellore, southern India. Clin Infect Dis 59 (Suppl 4): S295S299.[Crossref] [Google Scholar]
  26. John J, Giri S, Karthikeyan AS, Iturriza-Gomara M, Muliyil J, Abraham A, Grassly NC, Kang G, , 2014. Effect of a single inactivated poliovirus vaccine dose on intestinal immunity against poliovirus in children previously given oral vaccine: an open-label, randomised controlled trial. Lancet 384: 15051512.[Crossref] [Google Scholar]
  27. Gladstone BP, Muliyil JP, Jaffer S, Wheeler JG, Le Fevre A, Iturriza-Gomara M, Gray JJ, Bose A, Estes MK, Brown DW, Kang G, , 2008. Infant mortality in an urban slum birth cohort. Arch Dis Child 93: 479484.[Crossref] [Google Scholar]
  28. Sarkar R, Kattula D, Francis MR, Ajjampur SSR, Prabakaran AD, Jayavelu N, Muliyil J, Balraj V, Naumova EN, Ward HD, Kang G, , 2014. Risk factors for cryptosporidiosis among children in a semi urban slum in southern India: a nested case-control study. Am J Trop Med Hyg 91: 11281137.[Crossref] [Google Scholar]
  29. Houpt E, Gratz J, Kosek M, Zaidi AKM, Qureshi S, Kang G, Babji S, Mason C, Bodhidatta L, Samie A, Bessong P, Barrett L, Lima A, Havt A, Haque R, Mondal D, Taniuchi M, Stroup S, McGrath M, Lang D, , 2014. Microbiologic methods utilized in the MAL-ED cohort study. Clin Infect Dis 59 (Suppl 4): S225S232.[Crossref] [Google Scholar]
  30. Platts-Mills JA, Liu J, Gratz J, Mduma E, Amour C, Swai N, Taniuchi M, Begum S, Yori PP, Tilley DH, Lee G, Shen Z, Whary MT, Fox JG, McGrath M, Kosek M, Haque R, Houpt ER, , 2014. Detection of Campylobacter in stool and determination of significance by culture, enzyme immunoassay, and PCR in developing countries. J Clin Microbiol 52: 10741080.[Crossref] [Google Scholar]
  31. Liu J, Gratz J, Amour C, Kibiki G, Becker S, Janaki L, Verweij JJ, Taniuchi M, Sobuz SU, Haque R, Haverstick DM, Houpt ER, , 2013. A laboratory-developed TaqMan Array Card for simultaneous detection of 19 enteropathogens. J Clin Microbiol 51: 472480.[Crossref] [Google Scholar]
  32. Kageyama T, Kojima S, Shinohara M, Uchida K, Fukushi S, Hoshino FB, Takeda N, Katayama K, , 2003. Broadly reactive and highly sensitive assay for Norwalk-like viruses based on real-time quantitative reverse transcription-PCR. J Clin Microbiol 41: 15481557.[Crossref] [Google Scholar]
  33. Liu P, Hsaio H-M, Jaykus L-A, Moe C, , 2010. Quantification of Norwalk virus inocula: comparison of endpoint titration and real-time reverse transcription-PCR methods. J Med Virol 2010: 16121616.[Crossref] [Google Scholar]
  34. Collinet-Adler S, Babji S, Francis M, Kattula D, Premkumar PS, Sarkar R, Mohan VR, Ward H, Kang G, Balraj V, Naumova EN, , 2015. Environmental factors associated with high fly densities and diarrhea in Vellore, India. Appl Environ Microbiol 81: 60536058.[Crossref] [Google Scholar]
  35. Brick T, Primrose B, Chandrasekhar R, Roy S, Muliyil J, Kang G, , 2004. Water contamination in urban south India: household storage practices and their implications for water safety and enteric infections. Int J Hyg Environ Health 207: 473480.[Crossref] [Google Scholar]
  36. USEPA, 2002. Method 1604: Total Coliforms and Escherichia coli in Water by Membrane Filtration Using a Simultaneous Detection Medium (MI Medium). [Google Scholar]
  37. Gruber JS, Ercumen A, Colford JM, , 2014. Coliform bacteria as indicators of diarrheal risk in household drinking water: systematic review and meta-analysis. PLoS One 9: e107429.[Crossref] [Google Scholar]
  38. Platts-Mills JA, Babji S, Bodhidatta L, Gratz J, Haque R, Havt A, McCormick BJ, McGrath M, Olortegui MP, Samie A, Shakoor S, Mondal D, Lima IF, Hariraju D, Rayamajhi BB, Qureshi S, Kabir F, Yori PP, Mufamadi B, Amour C, Carreon JD, Richard SA, Lang D, Bessong P, Mduma E, Ahmed T, Lima AA, Mason CJ, Zaidi AK, Bhutta ZA, Kosek M, Guerrant RL, Gottlieb M, Miller M, Kang G, Houpt ER, , 2015. Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED). Lancet Glob Health 3: 564575.[Crossref] [Google Scholar]
  39. Okhuysen PC, Dupont HL, , 2010. Enteroaggregative Escherichia coli (EAEC): a cause of acute and persistent diarrhea of worldwide importance. J Infect Dis 202: 503505.[Crossref] [Google Scholar]
  40. Liu P, Hill VR, Hahn D, Johnson TB, Pan Y, Jothikumar N, Moe CL, , 2012. Hollow-fiber ultrafiltration for simultaneous recovery of viruses, bacteria and parasites from reclaimed water. J Microbiol Methods 88: 155161.[Crossref] [Google Scholar]
  41. R Core Team, 2015. R: A Language and Environment for Statistical Computing. Available at: https://www.r-project.org/. Accessed June 18, 2015. [Google Scholar]
  42. Heinze G, Ploner M, Dunkler D, Southworth H, , 2013. logistf: Firth's Bias Reduced Logistic Regression: Version 1.2.1. Available at: https://cran.r-project.org/package=logistf. Accessed September 1, 2015. [Google Scholar]
  43. Bates D, Maechler M, Bolker B, Walker S, , 2014. Fitting linear mixed-effects models using lme4. J Stat Softw 67: 148. http://arxiv.org/abs/1406.5823. [Google Scholar]
  44. Firth D, , 1993. Bias reduction of maximum likelihood estimates. Biometrika 80: 2738.[Crossref] [Google Scholar]
  45. Kulldorff M, , 1997. A spatial scan statistic. Commun Stat Meth 26: 14811496.[Crossref] [Google Scholar]
  46. Barreto ML, Genser B, Strina A, Teixeira MG, Assis AMO, Rego RF, Teles CA, Prado MS, Matos SMA, Santos DN, dos Santos LA, Cairncross S, , 2007. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet 370: 16221628.[Crossref] [Google Scholar]
  47. Kolahi A-A, Rastegarpour A, Sohrabi M-R, , 2009. The impact of an urban sewerage system on childhood diarrhoea in Tehran, Iran: a concurrent control field trial. Trans R Soc Trop Med Hyg 103: 500505.[Crossref] [Google Scholar]
  48. Moraes LR, Cancio JA, Cairncross S, Huttly S, , 2003. Impact of drainage and sewerage on diarrhoea in poor urban areas in Salvador, Brazil. Trans R Soc Trop Med Hyg 97: 153158. http://www.ncbi.nlm.nih.gov/pubmed/14584367.[Crossref] [Google Scholar]
  49. Okoh AI, Sibanda T, Gusha SS, , 2010. Inadequately treated wastewater as a source of human enteric viruses in the environment. Int J Environ Res Public Health 7: 26202637.[Crossref] [Google Scholar]
  50. Teunis PFM, Reese HE, Null C, Yakubu H, Moe CL, , 2016. Quantifying contact with the environment: behaviors of young children in Accra, Ghana. Am J Trop Med Hyg 94: 920931.[Crossref] [Google Scholar]
  51. Gretsch SR, Ampofo JA, Baker KK, Clennon J, Null CA, Peprah D, Reese H, Robb K, Teunis P, Wellington N, Yakubu H, Moe CL, , 2016. Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana. J Water Health 14: 255266.[Crossref] [Google Scholar]
  52. Perry S, De La Luz Sanchez M, Hurst PK, Parsonnet J, , 2005. Household transmission of gastroenteritis. Emerg Infect Dis 11: 10931096.[Crossref] [Google Scholar]
  53. Koné D, , 2010. Making urban excreta and wastewater management contribute to cities' economic development: a paradigm shift. Water Policy 12: 602610.[Crossref] [Google Scholar]
  54. Heijnen M, Routray P, Torondel B, Clasen T, , 2015. Shared sanitation versus individual household latrines in urban slums: a cross-sectional study in Orissa, India. Am J Trop Med Hyg 93: 263268.[Crossref] [Google Scholar]
  55. Exum NG, Olórtegui MP, Yori PP, Davis MF, Heaney CD, Kosek M, Schwab KJ, , 2016. Floors and toilets: association of floors and sanitation practices with fecal contamination in Peruvian Amazon peri-urban households. Environ Sci Technol 50: 73737381.[Crossref] [Google Scholar]
  56. Fuller JA, Clasen T, Heijnen M, Eisenberg JNS, , 2014. Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001–2011. Am J Trop Med Hyg 91: 173180.[Crossref] [Google Scholar]
  57. Heijnen M, Cumming O, Peletz R, Chan GK-S, Brown J, Baker K, Clasen T, , 2014. Shared sanitation versus individual household latrines: a systematic review of health outcomes. PLoS One 9: e93300.[Crossref] [Google Scholar]
  58. Exley JLR, Liseka B, Cumming O, Ensink JHJ, , 2015. The sanitation ladder, what constitutes an improved form of sanitation? Environ Sci Technol 49: 10861094.[Crossref] [Google Scholar]
  59. Briscoe J, , 1984. Intervention studies and the definition of dominant transmission routes. Am J Epidemiol 120: 449455.[Crossref] [Google Scholar]
  60. Fuller JA, Villamor E, Cevallos W, Trostle J, Eisenberg JNS, , 2016. I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador. Int J Epidemiol 45: 460469.[Crossref] [Google Scholar]
  61. Hacker KP, Seto KC, Costa F, Corburn J, Reis MG, Ko AI, Diuk-Wasser MA, , 2013. Urban slum structure: integrating socioeconomic and land cover data to model slum evolution in Salvador, Brazil. Int J Health Geogr 12: 45.[Crossref] [Google Scholar]
  62. Jenkins MW, Cumming O, Scott B, Cairncross S, , 2014. Beyond “improved” towards “safe and sustainable” urban sanitation: assessing the design, management and functionality of sanitation in poor communities of Dar es Salaam, Tanzania. J Water Sanit Hyg Dev 4: 131.[Crossref] [Google Scholar]
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  • Received : 03 Mar 2016
  • Accepted : 02 Dec 2016
  • Published online : 20 Mar 2017

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