A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

Tarique Md. Nurul Huda London School of Hygiene and Tropical Medicine, London, United Kingdom;
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Wolf-Peter Schmidt London School of Hygiene and Tropical Medicine, London, United Kingdom;

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Amy J. Pickering Stanford University, Stanford, California

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Zahid Hayat Mahmud International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Mohammad Sirajul Islam International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Md. Sajjadur Rahman International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Stephen P. Luby Stanford University, Stanford, California

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Adam Biran London School of Hygiene and Tropical Medicine, London, United Kingdom;

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We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6–24 months in rural Bangladesh. We defined “basic” sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: −0.31 log10 colony forming units [CFU]/toy ball; 95% confidence interval [CI]: −0.61, −0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: −0.38 log10 CFU/toy ball; 95% CI: −0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households.

Author Notes

Address correspondence to Tarique Md. Nurul Huda, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), IPH Building, 1st Floor, 68 Shaheed Tajudding Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. E-mail: tariquehuda@yahoo.com

Financial support: This research was made possible with UK Aid from the Department of International Development (DFID) as part of the SHARE research program (www.SHAREresearch.org). However, the views expressed do not necessarily reflect DFID’s official policies. The study was also partially funded by Water, Sanitation and Hygiene research group at icddr,b, Dhaka, Bangladesh.

Authors’ addresses: Tarique Md. Nurul Huda, Mohammad Sirajul Islam, and Md. Sajjadur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh, E-mails: tarique.huda@icddrb.org, sislam@icddrb.org, and srahman@icddrb.org. Wolf-Peter Schmidt and Adam Biran, Environmental Health Group, Department for Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: adam.biran@lshtm.ac.uk. Amy J. Pickering, Center for Innovation in Global Health, Stanford University, Stanford, CA, E-mail: amyjanel@gmail.com. Zahid Hayat Mahmud, Environmental Microbiology Laboratory, Laboratory Sciences and Services Division, icddr,b, Mohakhali, Dhaka, E-mail: zhmahmud@icddrb.org. Stephen P. Luby, Department of Medicine (Infectious Diseases and Geographic Medicine), Center for Innovation in Global Health, Stanford University, Stanford, CA, Department of Research, Center for Innovation in Global Health, Stanford University, Stanford, CA, Woods Institute for the Environment, Stanford University, Stanford, CA, and Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu.

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