Assessment of Fecal Exposure Pathways in Low-Income Urban Settings

Mole 23rd Conference August 24, 2012

Study Goals

• Address the scarcity of data available to

sanitation policy makers and implementers – Identify and describe:

• Sources and movement of human fecal contamination in low-income urban environment

• Behavior of adults and children that leads to exposure to various fecal contamination pathways

– Use new certified tools and approaches to determine which exposure pathways pose the greatest risk

This project consists of an in-depth, multi-disciplinary assessment of exposure to human fecal contamination in low-income neighborhoods of Accra.

Multiple Fecal Exposure Pathways

Hands

Drinking Water

Flies Food

Soil

Surface Water Slide courtesy of Dr. Karen Levy

Ho

use

ho

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Which Pathway Poses the Greatest Risk??

Study Phases • 4 year study made up of 2 phases • Phase 1:

– 15 months (Sept 2011- Dec 2012) • First of its kind • 4 study neighborhoods • Multi-disciplinary approach to assess human behavior and

environmental contamination in urban Accra

• Phase 1.5: – Jan 2013 – June 2013: Data analysis and development of

rapid assessment tools

• Phase 2: (July 2013- June 2014)- Extend and validate results of phase 1 and apply rapid assessment tools in a new context

Environmental Sampling and Behavior Observation

Sample type Number collected

Swabs 158

Handrinse 260

Particulate (Sand, soil and sediments)

191

Septage 3

Food 93

Stored HH and school water ,sachet water

125

Piped water and Ocean Water 90

Flies 48

Drains 76

Total samples 1044

Environmental sampling progress to date

E. Coli results

Type N % positive

Piped water 66 33.3%

Drinking water (HH and schools) 117 46.2%

Sea water 18 100%

Drain water 55 96%

Flood water 19 73.7%

Produce 97 83.5%

Soil, sand, sediment 183 90.7%

Swabs 142 67%

Flies 32 100%

Sewage 3 100%

Hand rinses 238 86.5%

Sachet rinses 36 22.2%

Total 938

Behavioral study progress to date

• 16 Focus Group Discussions

• 12 Key Informant Interviews

• 39 Child behavior observations

• 11 Beach observations

• 25 Nurseries and 27 Primary School observations

• 32 Public Latrine observations

• 15 Drain observation

• 146 Latrine exit interviews

Respondent status 69.6% F in HH

Tenancy 57% own

Compound or HH 68.8% compound

Business in HH 53.1% yes

Drinking water source 75.6% sachet

Latrine in HH 9 with access

Number of HH sharing latrine 4 share with other HH

Where ppl 5-12 yrs defecate 41.8% public latrine

Where youngest child defecates 44.8% diaper/nappy

Child age <2 years average

Child feces disposal 58.4% rubbish

Other HHs leave child feces on ground 64.4% no

Child had diarrhea (2 wks) 50.6% yes

Ever de-wormed child 41.2% yes

Latrine type 88.9% none Animals in compound 64% yes

Household Conditions Survey (n=89)

Children Under 5 Observations • 39 children observed • Behavior events per child: 16.1(6-28)

• 40 caregivers observed • Behavior events per caregiver: 3.4(1-10)

Upcoming study activities

• 600 Household Surveys linked with environmental sampling in all 4 communities starting next week

• Agricultural focused study starting in mid –September, 2012

• Full data analysis for development of rapid assessment tools and planning for phase 2