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Adhikari S, Hunter E, Vossenberg JVD, Thomas J. A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data. Int J Hyg Environ Health 2023; 254:114261. [PMID: 37734133 DOI: 10.1016/j.ijheh.2023.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.
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Affiliation(s)
- Sabita Adhikari
- School of Civil Engineering, The University of Sydney, Australia.
| | - Erin Hunter
- Department of Public Health Sciences, College of Behavioural, Social and Health Sciences, Clemson University, United States.
| | - Jack van de Vossenberg
- Water Supply, Sanitation and Environmental Engineering Department, IHE Delft Institute of Water Education, the Netherlands.
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Antwi-Agyei P, Monney I, Amaning Adjei K, Kweyu R, Simiyu S. Shared but Clean Household Toilets: What Makes This Possible? Evidence from Ghana and Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4271. [PMID: 35409952 PMCID: PMC8998870 DOI: 10.3390/ijerph19074271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Shared sanitation facilities are not considered as basic sanitation owing to cleanliness and accessibility concerns. However, there is mounting evidence that some shared household toilets have a comparable level of service as private toilets. This study examined the factors that contribute to the quality of shared household toilets in low-income urban communities in Ghana and Kenya. The study design comprised household surveys and field inspections. Overall, 843 respondents were interviewed, and 838 household shared sanitation facilities were inspected. Cleanliness scores were computed from the facility inspections, while a total quality score was calculated based on 13 indicators comprising hygiene, privacy, and accessibility. Regression analyses were conducted to determine predictors of cleanliness and the overall quality of the shared sanitation facilities. More than four out of five (84%) shared toilets in Ghana (N = 404) were clean, while in Kenya (N = 434), nearly a third (32%) were clean. Flush/pour-flush toilets were six times (p < 0.01 aOR = 5.64) more likely to be clean. A functional outside door lock on a toilet facility and the presence of live-in landlords led to a threefold increase (p < 0.01 aOR = 2.71) and a twofold increase (p < 0.01 aOR = 1.92), respectively in the odds of shared sanitation cleanliness. Sanitation facilities shared by at most five households (95% CI: 6−7) were generally clean. High-quality shared toilets had live-in landlords, functional door locks, and were water-dependent. Further studies on innovative approaches to maintaining the quality of these high-quality shared toilets are needed to make them eligible for classification as basic sanitation considering the increasing reliance on the facilities.
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Affiliation(s)
- Prince Antwi-Agyei
- Regional Centre of Energy and Environmental Sustainability (RCEES), Civil and Environmental Engineering Department, School of Engineering, University of Energy and Natural Resources (UENR), P.O. Box 214, Sunyani BS0061, Ghana
| | - Isaac Monney
- Department of Environmental Health and Sanitation Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, P.O. Box M40, Mampong 3JG3+PFQ, Ghana;
| | - Kwaku Amaning Adjei
- Department of Civil Engineering, Regional Water and Environmental Sanitation Centre (RWESCK), Kwame Nkrumah University of Science and Technology (KNUST), PMB, University Post Office, Kumasi AK448, Ghana;
| | - Raphael Kweyu
- Department of Geography, Kenyatta University, P.O. Box 43844, Nairobi 00100, Kenya;
| | - Sheillah Simiyu
- Urbanisation and Well-Being Unit, African Population & Health Research Center, P.O. Box 10787, Nairobi 00100, Kenya;
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Ssemugabo C, Wafula ST, Ndejjo R, Osuret J, Musoke D, Halage AA. Characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda. Int Health 2021; 13:13-21. [PMID: 32236413 PMCID: PMC7807239 DOI: 10.1093/inthealth/ihaa011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background This study assessed characteristics of sanitation and hygiene facilities in a slum community in Kampala, Uganda. Methods We conducted a household-based cross-sectional study among 395 households in Kasubi slum using a semi-structured questionnaire and observational checklist to collect data. Results Almost 98.0% (387/395) of households owned a sanitation facility and 77.0% (298/387) shared it with other households. The most common type of sanitation facility was a pit latrine with slab (66.9% [259/387]). Most (90.5% [305/337]) latrines had a door or shutter, a roof (92.9% [313/337]) and a depth >1.5 m (68.2% [229/337]). Overall, 21.3% (84/395) and 65.6% (259/395) of households had improved and functional sanitation facilities, respectively. Only 16.5% (65/395) of the households had a hand-washing facility. Student-led (adjusted prevalence rate [PR] 2.67 [95% confidence interval [CI] 1.83–3.94]) and households that owned their house (adjusted PR 2.17 [95% CI 1.33–3.53]) were 2.67 and 2.17 times more likely to have improved sanitation facilities, respectively. Households that owned their house (adjusted PR 1.90 [95% CI 1.18–3.05]) were 1.9 times more likely to possess a hand-washing facility. Conclusions The coverage of improved sanitation and hygiene facilities was low. The majority of households were using a shared pit latrine with a slab that had no hand-washing facility. Sanitation and hygiene interventions should prioritize improving sanitation and hygiene facilities.
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Affiliation(s)
- Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdullah Ali Halage
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Macleod CK, Binnawi KH, Elshafie BE, Sadig HE, Hassan A, Cocks N, Willis R, Chu B, Solomon AW. Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan. Trans R Soc Trop Med Hyg 2019; 113:599-609. [PMID: 31612959 PMCID: PMC6792159 DOI: 10.1093/trstmh/trz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To estimate the proportion of children with trachomatous inflammation-follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. METHODS IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014-2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. RESULTS Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1-9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1-9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. CONCLUSION Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.
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Affiliation(s)
- Colin K Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Kamal Hashim Binnawi
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
- Department of Ophthalmology, Al Neelain University, Khartoum, Sudan
| | - Balgesa Elkheir Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
| | - Husam Eldin Sadig
- Faculty of Mathematical Sciences and Statistics, Al-Neelain University, Sudan
| | | | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Rebecca Willis
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Brian Chu
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Gichuki PM, Kepha S, Mulewa D, Masaku J, Kwoba C, Mbugua G, Mazigo HD, Mwandawiro C. Association between Schistosoma mansoni infection and access to improved water and sanitation facilities in Mwea, Kirinyaga County, Kenya. BMC Infect Dis 2019; 19:503. [PMID: 31174478 PMCID: PMC6556037 DOI: 10.1186/s12879-019-4105-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Schistosomiasis remains a public health problem in Central Kenya despite concerted control efforts. Access to improved water and sanitation has been emphasized as important control measures. Few studies have assessed the association between access to improved water sources and sanitation facilities with Schistosoma mansoni infection in different environmental settings. This study assessed the association between S. mansoni infection and household access to improved water sources and sanitation facilities in Mwea, Kirinyaga County, Kenya. Methods A cross sectional study was conducted between the months of August and October 2017. A total of 905 household heads from seven villages were interviewed and their stool samples screened for S. mansoni using the Kato Katz technique. Comparisons of demographic factors by S. mansoni infection were tested for significance using the chi-square test (χ2) or the Fisher exact test for categorical variables. Variables associated with S. mansoni infection were analyzed using univariable analysis and the strength of the association measured as odds ratio (OR) using mixed effects logistic regression at 95% CI, with values considered significant at p < 0.05. Results The overall prevalence of S. mansoni was, 23.1% (95% CI: 20.5–26.0%), with majority of the infections being of light intensity. Rurumi village had the highest prevalence at 33.3%, with Kirogo village having the least prevalence at 7.0%. Majority (84.1%) of the households lacked access to improved water sources but had access to improved sanitation facilities (75%). Households with access to piped water had the lowest S. mansoni infections. However, there was no significant association between S. mansoni infections with either the main source of water in the household (Odds Ratio (OR) =0.782 (95% CI: 0.497–1.229) p = 0.285 or sanitation facilities (OR = 1.018 (95% CI: 0.705–1.469) p = 0.926. Conclusion Our study suggests that S. mansoni is still a public health problem among all age groups in Mwea irrigation scheme, Kirinyaga County, Central Kenya. Majority of the households lacks access to improved water sources but have access to improved sanitation facilities. This study recommends initiatives to ensure adequate provision of improved water sources, and the inclusion of the adult community in preventive chemotherapy programs. Electronic supplementary material The online version of this article (10.1186/s12879-019-4105-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul M Gichuki
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya. .,School of Health Sciences, Meru University of Science and Technology, P.O BOX 972-60200, Meru, Kenya.
| | - Stella Kepha
- London School of Tropical Medicine and Hygiene, Keppel St, Bloomsbury, London, WCIE 7HT, UK.,School of Public Health, Pwani University, P.O BOX 195-80108, Mombasa, Kenya
| | - Damaris Mulewa
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
| | - Janet Masaku
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
| | - Celestine Kwoba
- Vectorborne diseases Control Unit, Ministry of Health, P.o box 86-10303, Wanguru, Kenya
| | - Gabriel Mbugua
- School of Health Sciences, Meru University of Science and Technology, P.O BOX 972-60200, Meru, Kenya
| | - Humphrey D Mazigo
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Charles Mwandawiro
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
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Rashid M, Pandit D. Determination of Appropriate Service Delivery Level for Quantitative Attributes of Household Toilets in Rural Settlements of India from Users' Perspective. ENVIRONMENTAL MANAGEMENT 2018; 61:637-649. [PMID: 29330609 DOI: 10.1007/s00267-017-0987-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/29/2017] [Indexed: 06/07/2023]
Abstract
Improvement of quality of sanitation services in rural settlements is an important development goal in developing countries including India and accordingly several strategies are adopted which promote the demand and use of household toilets through creating awareness and providing subsidies to poor people for construction of household toilets with service-level standards specified from experts' perspective. In many cases, users are unsatisfied with the quality of toilets constructed using subsidies and the same remain unused. Users' satisfaction depends on their perceptions of service quality of individual attributes and overall service quality of the household toilets, which is an important determinant of sustainability and sustained use of toilets. This study aims to assess and benchmark the appropriate service delivery level for quantitative attributes of rural household toilets based on user perception. The service quality is determined with the help of level of service (LOS) scales developed using successive interval scaling technique, the zone of tolerance (ZOT), and users satisfaction level (USL) which relates service delivery levels with user satisfaction directly. The study finds that the service quality of most of the attributes of household toilets constructed using subsidies is perceived as poor. The results also suggest that most of the users expect to have a toilet with the service level of attributes ranging between LOS A and LOS B.
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Affiliation(s)
- Mohammad Rashid
- Department of Architecture and Regional Planning, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India.
| | - Debapratim Pandit
- Department of Architecture and Regional Planning, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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Sanders AM, Stewart AEP, Makoy S, Chebet JJ, Magok P, Kuol A, Blauvelt C, Lako R, Rumunu J, Callahan EK, Nash SD. Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys. PLoS Negl Trop Dis 2017; 11:e0005658. [PMID: 28614375 PMCID: PMC5484542 DOI: 10.1371/journal.pntd.0005658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/26/2017] [Accepted: 05/23/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed. METHODOLOGY/ PRINCIPAL FINDINGS Five counties (Budi, Lafon, Kapoeta East, Kapoeta South and Kapoeta North) were surveyed from April to October 2015. A cross-sectional, multi-stage, cluster-random sampling was used. All present, consenting residents of selected households were examined for all clinical signs of trachoma using the World Health Organization (WHO) simplified grading system. 14,462 individuals from 3,446 households were surveyed. The prevalence of trachomatous inflammation-follicular (TF) in children ages one to nine years ranged from 17.4% (95% Confidence Interval (CI): 11.4%, 25.6%) in Budi county to 47.6%, (95% CI: 42.3%, 53.0%) in Kapoeta East county. Trachomatous trichiasis (TT) was also highly prevalent in those 15 years and older, ranging between 2.6% (95% CI: 1.6%, 4.0%) in Kapoeta South to 3.9% (95% CI: 2.4%, 6.1%) in Lafon. The presence of water and sanitation were low in all five counties, including two counties which had a complete absence of latrines in all surveyed clusters. CONCLUSIONS/ SIGNIFICANCE To our knowledge, these were the first trachoma surveys conducted in the Republic of South Sudan since their independence in 2011. The results show that despite years of interventions, four of the five surveyed counties require a minimum of five additional years of SAFE strategy implementation, with the fifth requiring at minimum three more years.
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Affiliation(s)
- Angelia M. Sanders
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
- * E-mail:
| | - Aisha E. P. Stewart
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Samuel Makoy
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Joy J. Chebet
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Peter Magok
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Aja Kuol
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Carla Blauvelt
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - John Rumunu
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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Oswald WE, Stewart AE, Kramer MR, Endeshaw T, Zerihun M, Melak B, Sata E, Gessese D, Teferi T, Tadesse Z, Guadie B, King JD, Emerson PM, Callahan EK, Flanders D, Moe CL, Clasen TF. Active trachoma and community use of sanitation, Ethiopia. Bull World Health Organ 2017; 95:250-260. [PMID: 28479620 PMCID: PMC5407250 DOI: 10.2471/blt.16.177758] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1–9 years and community sanitation usage. Methods Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. Findings In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28–30) and mean community sanitation usage was 47% (95% CI: 45–48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57–1.03 and OR: 0.67; 95% CI: 0.48–0.95, respectively). Conclusion In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.
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Affiliation(s)
- William E Oswald
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | | | | | | | | | | | | | | | | | | | | | | | - Paul M Emerson
- The Carter Center, Atlanta, United States of America (USA)
| | | | - Dana Flanders
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Christine L Moe
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Thomas F Clasen
- Rollins School of Public Health, Emory University, Atlanta, USA
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Simiyu S, Swilling M, Cairncross S, Rheingans R. Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya. BMC Public Health 2017; 17:68. [PMID: 28077103 PMCID: PMC5225536 DOI: 10.1186/s12889-016-4009-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Shared facilities are not recognised as improved sanitation due to challenges of maintenance as they easily can be avenues for the spread of diseases. Thus there is need to evaluate the quality of shared facilities, especially in informal settlements, where they are commonly used. A shared facility can be equated to a common good whose management depends on the users. If users do not work collectively towards keeping the facility clean, it is likely that the quality may depreciate due to lack of maintenance. This study examined the quality of shared sanitation facilities and used the common pool resource (CPR) management principles to examine the determinants of shared sanitation quality in the informal settlements of Kisumu, Kenya. METHODS Using a multiple case study design, the study employed both quantitative and qualitative methods. In both phases, users of shared sanitation facilities were interviewed, while shared sanitation facilities were inspected. Shared sanitation quality was a score which was the dependent variable in a regression analysis. Interviews during the qualitative stage were aimed at understanding management practices of shared sanitation users. Qualitative data was analysed thematically by following the CPR principles. RESULTS Shared facilities, most of which were dirty, were shared by an average of eight households, and their quality decreased with an increase in the number of households sharing. The effect of numbers on quality is explained by behaviour reflected in the CPR principles, as it was easier to define boundaries of shared facilities when there were fewer users who cooperated towards improving their shared sanitation facility. Other factors, such as defined management systems, cooperation, collective decision making, and social norms, also played a role in influencing the behaviour of users towards keeping shared facilities clean and functional. CONCLUSION Apart from hardware factors, quality of shared sanitation is largely due to group behaviour of users. The CPR principles form a crucial lens through which the dynamics of shared sanitation facilities in informal settlements can be understood. Development and policy efforts should incorporate group behaviour as they determine the quality of shared sanitation facilities.
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Affiliation(s)
- Sheillah Simiyu
- School of Public Leadership, Stellenbosch University, Private Bag, X1, Matieland, 7602 Stellenbosch South Africa
- Great Lakes University of Kisumu (GLUK), Box 2224-40100, Kisumu, Kenya
| | - Mark Swilling
- School of Public Leadership, Stellenbosch University, Private Bag, X1, Matieland, 7602 Stellenbosch South Africa
| | - Sandy Cairncross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Richard Rheingans
- Department of Environmental and Global Health, University of Florida, Gainesville, FL 32611 USA
- Sustainable Development Department, Appalachian State University, 287 Rivers St, Boone, NC USA
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10
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Sinha A, Nagel CL, Thomas E, Schmidt WP, Torondel B, Boisson S, Clasen TF. Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors. Am J Trop Med Hyg 2016; 95:720-727. [PMID: 27458042 PMCID: PMC5014284 DOI: 10.4269/ajtmh.16-0102] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/31/2016] [Indexed: 11/07/2022] Open
Abstract
Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability of methods to assess latrine use is uncertain. We assessed the reliability of reported use, the standard method, by comparing survey-based responses against passive latrine use monitors (PLUMs) through a cross-sectional study among 292 households in 25 villages in rural Odisha, India, which recently received individual household latrines under the TSC. PLUMs were installed for 2 weeks and householders responded to surveys about their latrine use behavior. Reported use was compared with PLUM results using Bland-Altman (BA) plots and concordance statistics. Reported use was higher than corresponding PLUM-recorded events across the range of comparisons. The mean reported "usual" daily events per household (7.09, 95% confidence interval [CI] = 6.51, 7.68) was nearly twice that of the PLUM-recorded daily average (3.62, 95% CI = 3.29, 3.94). There was poor agreement between "usual" daily latrine use and the average daily PLUM-recorded events (ρc = 0.331, 95% CI = 0.242, 0.427). Moderate agreement (ρc = 0.598, 95% CI = 0.497, 0.683) was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Reported latrine use, though already suggesting suboptimal adoption, likely exaggerates the actual level of uptake of latrines constructed under the program. Where reliance on self-reports is used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about "usual" latrine use behavior.
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Affiliation(s)
- Antara Sinha
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Corey L Nagel
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Evan Thomas
- The Portland State University SWEETLab, Portland, Oregon
| | - Wolf P Schmidt
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Belen Torondel
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sophie Boisson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas F Clasen
- Department of Environment Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Yimam YT, Gelaye KA, Chercos DH. Latrine utilization and associated factors among people living in rural areas of Denbia district, Northwest Ethiopia, 2013, a cross-sectional study. Pan Afr Med J 2014; 18:334. [PMID: 25478055 PMCID: PMC4250030 DOI: 10.11604/pamj.2014.18.334.4206] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/23/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction In Ethiopia up to 60% of the current disease burden is attributable to poor sanitation. Latrine facility coverage is increasing since Health Extension Program started, whereas less attention to quality and utilization of latrine facilities in rural Ethiopia. Methods A community based cross-sectional study design with multistage sampling technique was employed to collect data from total of 806 households. Results A total of 801 households with latrines were assessed for their latrine utilization status. The extent of latrine utilization among 490 (61.2%) households was satisfactory. Presence of ≤5 children (AOR: 0.379, 95% CI :( 0.196, 0.732)), job of mothers (being farmer) (AOR: 0.321, 95%CI :( 0.136, 0.757)) and rare cleaning frequency (AOR: 0.055, 95% CI :( 0.005, 0.620)) were a factor negatively associated with latrine utilization. Whereas the presence of secondary school children (AOR: 3.739, 95% CI (1.884, 7.419), educational status of mothers (AOR: 2.437, 95% CI (1.032, 5.756), latrine constructed for the second time (AOR: 2.676, 95% CI :( 1.352, 5.299)), presence of door (AOR: 3.201, 95% CI: (1.437, 7.130)), the hygienic condition of latrine (AOR: 4.327, 95% CI: (2.05, 9.134)) were factors positively associated with latrine utilization. Conclusion Latrine utilization rate of household latrines was satisfactory. The presence of ≤ 5 years children, job of mother (farmer), educational status of mothers, presence of secondary school student, the presence of the door, frequency of latrine construction, and hygienic condition of latrine were significant predictors of latrine utilization.
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Affiliation(s)
- Yimam Tadesse Yimam
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Ethiopia
| | - Daniel Haile Chercos
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Ethiopia
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Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls? WATER 2014. [DOI: 10.3390/w6051453] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vujcic J, Ram PK, Hussain F, Unicomb L, Gope PS, Abedin J, Mahmud ZH, Islam MS, Luby SP. Toys and toilets: cross-sectional study using children's toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices. Trop Med Int Health 2014; 19:528-36. [PMID: 24645919 DOI: 10.1111/tmi.12292] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate household faecal contamination using children's toys among 100 rural Bangladeshi households categorised as 'cleaner' (toilet that reliably separates faeces from the environment and no human faeces in/around living space) or 'less clean' (no toilet or toilet that does not reliably separate faeces from the environment and human faeces in/around living space). METHODS We distributed toy balls to each household and rinsed each study toy and a toy already owned by the household in 200 ml of Ringer's solution. We enumerated faecal coliforms and faecal streptococci from each rinse using membrane filtration methods. RESULTS Study toys from 39 cleaner households had lower mean faecal coliform contamination than toys from 61 less clean households (2.4 log10 colony-forming units (CFU)/200 ml vs. 3.2 log10 CFU/200 ml, P = 0.03). However, wealth measures explained a portion of this relationship. Repeat measures were moderately variable [coefficient of variation (CV) = 6.5 between two toys in the household at the same time, CV = 37.6 between toys in the household at two different times 3-4 days apart]. Too few households owned a non-porous toy to compare groups without risk of bias. CONCLUSION In rural Bangladesh, improved sanitation facilities and practices were associated with less environmental contamination. Whether this association is independent of household wealth and whether the difference in contamination improves child health merit further study. The variation found was typical for measures of environmental contamination, and requires large sample sizes to ascertain differences between groups with statistical significance.
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Affiliation(s)
- Jelena Vujcic
- State University of New York at Buffalo, New York, NY, USA
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Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001605. [PMID: 24586120 PMCID: PMC3934994 DOI: 10.1371/journal.pmed.1001605] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trachoma is the world's leading cause of infectious blindness. The World Health Organization (WHO) has endorsed the SAFE strategy in order to eliminate blindness due to trachoma by 2020 through "surgery," "antibiotics," "facial cleanliness," and "environmental improvement." While the S and A components have been widely implemented, evidence and specific targets are lacking for the F and E components, of which water, sanitation, and hygiene (WASH) are critical elements. Data on the impact of WASH on trachoma are needed to support policy and program recommendations. Our objective was to systematically review the literature and conduct meta-analyses where possible to report the effects of WASH conditions on trachoma and identify research gaps. METHODS AND FINDINGS We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through October 27, 2013 with no restrictions on language or year of publication. Studies were eligible for inclusion if they reported a measure of the effect of WASH on trachoma, either active disease indicated by observed signs of trachomatous inflammation or Chlamydia trachomatis infection diagnosed using PCR. We identified 86 studies that reported a measure of the effect of WASH on trachoma. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. If three or more studies reported measures of effect for a comparable WASH exposure and trachoma outcome, we conducted a random-effects meta-analysis. We conducted 15 meta-analyses for specific exposure-outcome pairs. Access to sanitation was associated with lower trachoma as measured by the presence of trachomatous inflammation-follicular or trachomatous inflammation-intense (TF/TI) (odds ratio [OR] 0.85, 95% CI 0.75-0.95) and C. trachomatis infection (OR 0.67, 95% CI 0.55-0.78). Having a clean face was significantly associated with reduced odds of TF/TI (OR 0.42, 95% CI 0.32-0.52), as were facial cleanliness indicators lack of ocular discharge (OR 0.42, 95% CI 0.23-0.61) and lack of nasal discharge (OR 0.62, 95% CI 0.52-0.72). Facial cleanliness indicators were also associated with reduced odds of C. trachomatis infection: lack of ocular discharge (OR 0.40, 95% CI 0.31-0.49) and lack of nasal discharge (OR 0.56, 95% CI 0.37-0.76). Other hygiene factors found to be significantly associated with reduced TF/TI included face washing at least once daily (OR 0.76, 95% CI 0.57-0.96), face washing at least twice daily (OR 0.85, 95% CI 0.80-0.90), soap use (OR 0.76, 95% CI 0.59-0.93), towel use (OR 0.65, 95% CI 0.53-0.78), and daily bathing practices (OR 0.76, 95% CI 0.53-0.99). Living within 1 km of a water source was not found to be significantly associated with TF/TI or C. trachomatis infection, and the use of sanitation facilities was not found to be significantly associated with TF/TI. CONCLUSIONS We found strong evidence to support F and E components of the SAFE strategy. Though limitations included moderate to high heterogenity, low study quality, and the lack of standard definitions, these findings support the importance of WASH in trachoma elimination strategies and the need for the development of standardized approaches to measuring WASH in trachoma control programs.
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Affiliation(s)
- Meredith E. Stocks
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Stephanie Ogden
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Danny Haddad
- Emory Eye Center, Emory University, Atlanta, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Courtney McGuire
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew C. Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
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Barnard S, Routray P, Majorin F, Peletz R, Boisson S, Sinha A, Clasen T. Impact of Indian Total Sanitation Campaign on latrine coverage and use: a cross-sectional study in Orissa three years following programme implementation. PLoS One 2013; 8:e71438. [PMID: 23990955 PMCID: PMC3749227 DOI: 10.1371/journal.pone.0071438] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Faced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. In settings like rural India where open defecation is common, this may result in sub-optimal compliance (use), thereby continuing to leave the population exposed to human excreta. METHODS We conducted a cross-sectional study to investigate latrine coverage and use among 20 villages (447 households, 1933 individuals) in Orissa, India where the Government of India's Total Sanitation Campaign had been implemented at least three years previously. We defined coverage as the proportion of households that had a latrine; for use we identified the proportion of households with at least one reported user and among those, the extent of reported use by each member of the household. RESULTS Mean latrine coverage among the villages was 72% (compared to <10% in comparable villages in the same district where the Total Sanitation Campaign had not yet been implemented), though three of the villages had less than 50% coverage. Among these households with latrines, more than a third (39%) were not being used by any member of the household. Well over a third (37%) of the members of households with latrines reported never defecating in their latrines. Less than half (47%) of the members of such households reported using their latrines at all times for defecation. Combined with the 28% of households that did not have latrines, it appears that most defecation events in these communities are still practiced in the open. CONCLUSION A large-scale campaign to implement sanitation has achieved substantial gains in latrine coverage in this population. Nevertheless, gaps in coverage and widespread continuation of open defecation will result in continued exposure to human excreta, reducing the potential for health gains.
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Affiliation(s)
- Sharmani Barnard
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Parimita Routray
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona Majorin
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel Peletz
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sophie Boisson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Antara Sinha
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas Clasen
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Lavett DK, Lansingh VC, Carter MJ, Eckert KA, Silva JC. Will the SAFE strategy be sufficient to eliminate trachoma by 2020? Puzzlements and possible solutions. ScientificWorldJournal 2013; 2013:648106. [PMID: 23766701 PMCID: PMC3671555 DOI: 10.1155/2013/648106] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia.
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Affiliation(s)
- Diane K. Lavett
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Van C. Lansingh
- International Agency for the Prevention of Blindness/VISION 2020 Latin America, 3720 San Simeon Circle, Weston, FL 33331, USA
- Hamilton Eye Institute, University of Memphis, Memphis, TN 38152, USA
| | - Marissa J. Carter
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Kristen A. Eckert
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
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Enger KS, Nelson KL, Rose JB, Eisenberg JNS. The joint effects of efficacy and compliance: a study of household water treatment effectiveness against childhood diarrhea. WATER RESEARCH 2013; 47:1181-90. [PMID: 23290123 DOI: 10.1016/j.watres.2012.11.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/26/2012] [Accepted: 11/21/2012] [Indexed: 05/04/2023]
Abstract
The effectiveness of household water treatment (HWT) at reducing diarrheal disease is related to the efficacy of the HWT method at removing pathogens, how people comply with HWT, and the relative contributions of other pathogen exposure routes. We define compliance with HWT as the proportion of drinking water treated by a community. Although many HWT methods are efficacious at removing or inactivating pathogens, their effectiveness within actual communities is decreased by imperfect compliance. However, the quantitative relationship between compliance and effectiveness is poorly understood. To assess the effectiveness of HWT on childhood diarrhea incidence via drinking water for three pathogen types (bacterial, viral, and protozoan), we developed a quantitative microbial risk assessment (QMRA) model. We examined the relationship between log(10) removal values (LRVs) and compliance with HWT for scenarios varying by: baseline incidence of diarrhea; etiologic fraction of diarrhea by pathogen type; pattern of compliance within a community; and size of contamination spikes in source water. Benefits from increasing LRVs strongly depend on compliance. For perfect compliance, diarrheal incidence decreases as LRVs increase. However, if compliance is incomplete, there are diminishing returns from increasing LRVs in most of the scenarios we considered. Higher LRVs are more beneficial if: contamination spikes are large; contamination levels are generally high; or some people comply perfectly. The effectiveness of HWT interventions at the community level may be limited by imperfect compliance, such that the benefits of high LRVs are not realized. Compliance with HWT should be carefully measured during HWT field studies and HWT dissemination programs. Studies of pathogen concentrations in a variety of developing-country source waters are also needed. Guidelines are needed for measuring and promoting compliance with HWT.
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Affiliation(s)
- Kyle S Enger
- Department of Fisheries and Wildlife, 13 Natural Resources Building, Michigan State University, East Lansing, MI 48824, USA
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18
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Amza A, Kadri B, Nassirou B, Stoller NE, Yu SN, Zhou Z, Chin S, West SK, Bailey RL, Mabey DCW, Keenan JD, Porco TC, Lietman TM, Gaynor BD. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis 2012; 6:e1586. [PMID: 22545165 PMCID: PMC3335874 DOI: 10.1371/journal.pntd.0001586] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 02/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trachoma control programs utilize mass azithromycin distributions to treat ocular Chlamydia trachomatis as part of an effort to eliminate this disease world-wide. But it remains unclear what the community-level risk factors are for infection. METHODS This cluster-randomized, controlled trial entered 48 randomly selected communities in a 2×2 factorial design evaluating the effect of different treatment frequencies and treatment coverage levels. A pretreatment census and examination established the prevalence of risk factors for clinical trachoma and ocular chlamydia infection including years of education of household head, distance to primary water source, presence of household latrine, and facial cleanliness (ocular discharge, nasal discharge, and presence of facial flies). Univariate and multivariate associations were tested using linear regression and Bayes model averaging. FINDINGS There were a total of 24,536 participants (4,484 children aged 0-5 years) in 6,235 households in the study. Before treatment in May to July 2010, the community-level prevalence of active trachoma (TF or TI utilizing the World Health Organization [WHO] grading system) was 26.0% (95% CI: 21.9% to 30.0%) and the mean community-level prevalence of chlamydia infection by Amplicor PCR was 20.7% (95% CI: 16.5% to 24.9%) in children aged 0-5 years. Univariate analysis showed that nasal discharge (0.29, 95% CI: 0.04 to 0.54; P = 0.03), presence of flies on the face (0.40, 95% CI: 0.17 to 0.64; P = 0.001), and years of formal education completed by the head of household (0.07, 95% CI: 0.07 to 0.13; P = 0.03) were independent risk factors for chlamydia infection. In multivariate analysis, facial flies (0.26, 95% CI: 0.02 to 0.49; P = 0.03) and years of formal education completed by the head of household (0.06, 95% CI: 0.008 to 0.11; P = 0.02) were associated risk factors for ocular chlamydial infection. INTERPRETATION We have found that the presence of facial flies and years of education of the head of the household are risk factors for chlamydia infection when the analysis is done at the community level. TRIAL REGISTRATION ClinicalTrials.gov NCT00792922.
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Affiliation(s)
- Abdou Amza
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Boubacar Kadri
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Baido Nassirou
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Nicole E. Stoller
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Sun N. Yu
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Zhaoxia Zhou
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Stephanie Chin
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Robin L. Bailey
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeremy D. Keenan
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
| | - Travis C. Porco
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
- Center for Infectious Disease and Emergency Readiness, University of California, Berkeley, California, United States of America
| | - Thomas M. Lietman
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
| | - Bruce D. Gaynor
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Clasen T, Fabini D, Boisson S, Taneja J, Song J, Aichinger E, Bui A, Dadashi S, Schmidt WP, Burt Z, Nelson KL. Making sanitation count: developing and testing a device for assessing latrine use in low-income settings. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2012; 46:3295-3303. [PMID: 22321123 DOI: 10.1021/es2036702] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
While efforts are underway to expand latrine coverage to an estimated 2.6 billion people who lack access to improved sanitation, there is evidence that actual use of latrines is suboptimal, limiting the potential health and environmental gains from containment of human excreta. We developed a passive latrine use monitor (PLUM) and compared its ability to measure latrine activity with structured observation. Each PLUM consisted of a passive infrared motion detector, microcontroller, data storage card, and batteries mounted in a small plastic housing that was positioned inside the latrine. During a field trial in Orissa, India, with ∼115 households, the number of latrine events measured by the PLUMs was in good agreement with that measured by trained observers during 5 h of structured observation per device per week. A significant finding was that the presence of a human observer was associated with a statistically significant increase in the number of latrine events, i.e., the users modified their behavior in response to the observer. Another advantage of the PLUM was the ability to measure activity continuously for an entire week. A shortcoming of the PLUM was the inability to separate latrine events that occurred in immediate succession, leading to possible undercounting during high-traffic periods. The PLUM is a promising technology that can provide detailed measures of latrine use to improve the understanding of sanitation behaviors and how to modify them and for assessing the intended health, livelihood, and environmental benefits of improved sanitation.
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Affiliation(s)
- Thomas Clasen
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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Montgomery MA, Desai MM, Groce NE, Elimelech M. Relationship between distance to social gathering facilities and risk of trachoma for households in rural Tanzanian communities. Soc Sci Med 2011; 73:1-5. [PMID: 21641706 DOI: 10.1016/j.socscimed.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 03/17/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
Few studies have examined the physical isolation of households with trachoma cases. Thus, in this study, we sought to examine the association between household isolation, as measured by distance to social gathering facilities, and risk of trachoma. We hypothesized that households located closer to such facilities would have a decreased risk of trachoma, due to a variety of social, economic, and cultural reasons. To test this hypothesis we conducted a case-control study of 668 households (93 cases, 575 controls) in eight villages in Kongwa District, Tanzania, in 2007. Case households were defined as having a child aged 1-5 years with clinical signs of trachoma. Distance of household's place of residence to three main social gathering facilities - bars/cafés, religious establishments, and commercial/government center - was measured with a portable geographic positioning system. Multiple logistic regression analyses, which controlled for potential confounders and accounted for clustering, demonstrated increased risk of trachoma with increasing distance to social gathering facilities. Compared with distances of ≤700 m, odds of trachoma were approximately two-fold higher for households living >1400 m from bars/cafés and from religious establishments, suggesting increased risk of trachoma for households at the fringes of communities. Targeting these isolated households with special programming along with dissemination through trusted social gathering facilities may improve effectiveness of current prevention efforts.
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Harding-Esch EM, Edwards T, Mkocha H, Munoz B, Holland MJ, Burr SE, Sillah A, Gaydos CA, Stare D, Mabey DCW, Bailey RL, West SK. Trachoma prevalence and associated risk factors in the gambia and Tanzania: baseline results of a cluster randomised controlled trial. PLoS Negl Trop Dis 2010; 4:e861. [PMID: 21072224 PMCID: PMC2970530 DOI: 10.1371/journal.pntd.0000861] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 09/29/2010] [Indexed: 11/23/2022] Open
Abstract
Background Blinding trachoma, caused by ocular infection with Chlamydia trachomatis, is targeted for global elimination by 2020. Knowledge of risk factors can help target control interventions. Methodology/Principal Findings As part of a cluster randomised controlled trial, we assessed the baseline prevalence of, and risk factors for, active trachoma and ocular C. trachomatis infection in randomly selected children aged 0–5 years from 48 Gambian and 36 Tanzanian communities. Both children's eyes were examined according to the World Health Organization (WHO) simplified grading system, and an ocular swab was taken from each child's right eye and processed by Amplicor polymerase chain reaction to test for the presence of C. trachomatis DNA. Prevalence of active trachoma was 6.7% (335/5033) in The Gambia and 32.3% (1008/3122) in Tanzania. The countries' corresponding Amplicor positive prevalences were 0.8% and 21.9%. After adjustment, risk factors for follicular trachoma (TF) in both countries were ocular or nasal discharge, a low level of household head education, and being aged ≥1 year. Additional risk factors in Tanzania were flies on the child's face, being Amplicor positive, and crowding (the number of children per household). The risk factors for being Amplicor positive in Tanzania were similar to those for TF, with the exclusion of flies and crowding. In The Gambia, only ocular discharge was associated with being Amplicor positive. Conclusions/Significance These results indicate that although the prevalence of active trachoma and Amplicor positives were very different between the two countries, the risk factors for active trachoma were similar but those for being Amplicor positive were different. The lack of an association between being Amplicor positive and TF in The Gambia highlights the poor correlation between the presence of trachoma clinical signs and evidence of C. trachomatis infection in this setting. Only ocular discharge was associated with evidence of C. trachomatis DNA in The Gambia, suggesting that at this low endemicity, this may be the most important risk factor. Trial Registration ClinicalTrials.gov NCT00792922 Trachoma is caused by Chlamydia trachomatis and is the leading infectious cause of blindness. The World Health Organization's (WHO) control strategy includes antibiotic treatment of all community members, facial cleanliness, and environmental improvements. By determining how prevalent trachoma is, decisions can be made whether control activities need to be put in place. Knowing what factors make people more at risk of having trachoma can help target trachoma control efforts to those most at risk. We looked at the prevalence of active trachoma and C. trachomatis infection in the eyes of children aged 0–5 years in The Gambia and Tanzania. We also measured risk factors associated with having active trachoma or infection. The prevalence of both active trachoma and infection was lower in The Gambia (6.7% and 0.8%, respectively) than in Tanzania (32.3% and 21.9%, respectively). Risk factors for active trachoma were similar in the two countries. For infection, the risk factors in Tanzania were similar to those for TF, whereas in The Gambia, only ocular discharge was associated with infection. These results show that although the prevalence of active trachoma and infection is very different between the two countries, the risk factors for active trachoma are similar but those for infection are different.
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Affiliation(s)
- Emma M Harding-Esch
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Montgomery MA, Bartram J. Short-sightedness in sight-saving: half a strategy will not eliminate blinding trachoma. Bull World Health Organ 2010; 88:82. [PMID: 20428358 DOI: 10.2471/blt.09.075424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Montgomery MA, Desai MM, Elimelech M. Comparing the effectiveness of shared versus private latrines in preventing trachoma in rural Tanzania. Am J Trop Med Hyg 2010; 82:693-5. [PMID: 20348521 DOI: 10.4269/ajtmh.2010.09-0540] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Sharing latrines is common in sub-Saharan Africa with anecdotal accounts suggesting a link between water-, sanitation-, and hygiene-related disease and poorly maintained communal latrines. This study examines this link by assessing the association between shared latrines compared with private latrines and risk of trachoma. In 2007, as part of a larger case-control study, we conducted a sub-study on latrine sharing in 594 households (92 cases, 502 controls) in seven rural Tanzanian communities. Case households were defined by having a child with clinical signs of trachoma. Latrine use was associated with a decreased risk of trachoma and there was no difference in risk between households using shared compared with private latrines (adjusted odds ratio = 0.95 [95% confidence interval = 0.55-1.67]). This study emphasizes the need to promote latrine use, which can be facilitated through latrine sharing in resource scarce areas, for prevention of trachoma.
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Affiliation(s)
- Maggie A Montgomery
- Civil and Environmental Engineering, Stanford University, Stanford, CA 94305, USA.
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