The SaniPath Tool: An Integrated Project Management, Data Analysis, and Visualization Platform

S Raj, Y Wang, A White, N Kishore, J Michiel, C Siesel, CL Moe

UNC Water and Health Conference (October 2018) Suraja Raj presented a poster at the UNC Water and Health Conference in October, 2018, highlighting new developments related to the new SaniPath Tool. The SaniPath Tool examines human exposure to fecal contamination in low-resource urban settings. It provides guidance for primary data collection, automated exposure analysis, and results visualizations that are accessible to people from a range of scientific backgrounds. This poster describes the development of a tool that allows users to plan a SaniPath deployment, set up and manage mobile data collection, analyze results, and generate reports. The tool guides users through steps of implementing the tool–from planning to data analysis. The tool is composed of a project planning and management interface, mobile data collection and data repository, and a data analysis and visualization dashboard. The tool can be customized to suit context-specific data collection needs. The SaniPath Tool is built on an integrated system of existing open source technologies and a tailored project management interface. It guides users through project configuration, training, and deployment by automating the customization and analysis processes. The Tool also uses an open source mobile data collection software, KoboToolbox (KT), which provides the backbone of data collection and storage. Data is collected via downloadable mobile forms used on Android devices and is uploaded to KT, which is paired with Enketo for online web data entry or editing. The tool automatically retrieves data from KT and generates exposure assessments for each study site and exposure pathway. Users can view and analyze the collected data, access data visualizations, and create a draft final report. The services are deployed on Amazon Web Services (AWS) infrastructure and backups are stored in S3 buckets for redundant data storage. The SaniPath Tool is an innovative use of mHealth in the WASH sector and can serve as an example of how open source software can be used to synthesize and analyze complex information and encourage public health evidence-based decision-making about urban sanitation investment.

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Risk of Exposure to Fecal Contamination in 10 Neighborhoods Across Dhaka, Bangladesh

CL Moe, J Green, S Raj, Y Wang, N Amin, S Ali, M Rahman, I Hasan, Z Hasan, S Haque, G Joseph American Society of Tropical Medicine and Hygiene Conference (October 2018)

Dhaka, Bangladesh has experienced rapid population growth and challenges meeting sanitation service demands. Poor sanitation and fecal sludge management can lead to fecal contamination in the urban environment. To understand risk of exposure to fecal contamination, an assessment of 10 environmental pathways was conducted using the SaniPath Tool. Data were collected from 10 neighborhoods (6 low-income, 2 mixed-income, and 2 high-income) throughout Dhaka between April-June 2017. 1000 environmental samples were collected from shared latrines, public play areas, produce in markets, street food, open drains, flood waters, surface waters, bathing water, municipal water, and non-municipal water. Samples were analyzed using IDEXX-Colilert-24® Quanti-Tray/2000 to determine most probable number (MPN) of E. coli. Behavior surveys were conducted with households, school children, and community groups to understand interaction with the environment. Using Bayesian methods, the behavioral and microbiological data were used to estimate the percentage of the population exposed and mean dose of fecal exposure (E. coli) for each environmental pathway in each neighbourhood. For adults, consumption of raw produce was the dominant exposure pathway (i.e. makes greatest contribution to total exposure) in 6 of the 10 neighborhoods. The percentage of adults exposed to fecal contamination through ingestion of raw produce ranged from 78-99% and the mean dose ranged from 104.8 to 107.5 MPN of E. coli ingested/month. The most common dominant pathway of exposure amongst children (8/10 neighborhoods) was accidental ingestion of drain water from playing in, or passing through, open drains (up to 94% exposed; mean dose of 107.8 MPN of E. coli ingested/month). Ingestion of fecal contamination via produce and street food was a high risk throughout Dhaka, while exposure to fecal contamination via municipal drinking water was mainly greater risk for those living in the south of the city. These results can guide city-wide WASH programming to prioritize interventions aimed at dominant exposure pathways and increase the potential for public health impact.