Makerere University Presents SaniPath Results from Kampala, Uganda at Stockholm World Water Week

Our colleague from Makerere University, Dr. Richard Mugambe, presented results from a SaniPath Exposure Assessment performed in Kampala, Uganda during a session at the Stockholm World Water Week Conference entitled "Tools to Support Climate-Smart Sanitation Decision-Making for the Urban Poor". During the session, Dr. Mugambe spoke alongside speakers from the Global Water Pathogen Project and HyCRISTAL about how complementary tools can be used to address important public health questions, such as "What areas of the city are predicted to have the highest health hazard from exposure to excreta?" and "What interventions can be made to reduce health risks from exposure to excreta in the environment?". These study questions were addressed in a Kampala case study to demonstrate the utility of complementary tools for climate-friendly sanitation decisions.

A link to the presentation recordings can be found here.

Exploring Relationship Between Fecal Exposure Pathways and Enteric Infections in Children in Vellore

UNC Water and Health Conference

Presenter: Sydney Hubbard

Rapid urbanization has led to a sanitation crisis in many low- and middle-income countries (LMIC). Studies of exposure to fecal contamination through different pathways have been conducted in LMICs. However, it is not clear whether exposure to fecal indicators (e.g. E. coli) from these pathways is associated with health outcomes (e.g. infection/illness). In March 2014, SaniPath in collaboration with the Christian Medical College (CMC) of Vellore, India conducted a cross-sectional exposure assessment in Old Town, a dense, urban unplanned settlement in Vellore. A total of 191 samples were collected from open drains, drinking water, public latrines, soil, raw produce, bathing water, child handrinse, and toy feeding spoon rinse and analyzed for E. coli using membrane filtration method. Spatial coordinates were also collected for each sample. From March 2010 - February 2012, the MAL-ED study, a multi-site project examining enteric infections, enteric dysfunction, and growth outcomes, enrolled a birth cohort of 190 children in Old Town, Vellore. At least 16 stool samples were collected from each child over two years of follow up and were tested for multiple bacterial and viral pathogens. Symptomatic illness was recorded. Geospatial data for Old Town, including open drains, water pipe network, open defecation areas, were extracted from shape files provided by CMC. Under the assumption that the urban environment and the exposure behaviors did not change dramatically between the close of the cohort in 2014 and the SaniPath assessment the same year, each child in the MALED study was linked with the closest environmental samples for each sample type from the SaniPath study. Spatial variables like the distance to the closest open defecation site, cumulative open drain/street/waterpipe lengths within a 100-meter radius, and the number of children also enrolled in the cohort within a 100-meter radius were generated. Generalized linear models were used with the bacterial infection rate, viral infection rate, and symptomatic illness rate as outcomes and environmental fecal contamination from different pathways and spatial variables as covariates. E. coli concentration from the closest public latrine and the distance to the closest open defecation site were significant predictors of bacterial infections in children. The sum of the open drain lengths within a 100-meter radius of the child, as well as the sum of street lengths within a 100-meter radius of the child, were significant predictors of viral infections in children. The E. coli concentration of the closest piped water was the only significant predictor of symptomatic illness in children. These preliminary findings that connect health outcomes to environmental exposure pathways and spatial information indicate differential risk factors for bacterial infections, viral infections, and symptomatic enteric illness in children under 2. These results highlight the need for safe excreta management in dense, urban settings to prevent bacterial infections, while contaminated drinking water seems to be a major driver of symptomatic illness in this population. Human congestion, as proxied by summative surrounding street lengths and open drains, is a key risk factor for viral infection.

FSM5 & AfricaSan5 Conference: Public Health Data in Sanitation Planning Workshop

Workshop convened by: Emory University Center for Global Safe WASH, Lusaka City Council, Kampala Capital City Authority, Makerere University School of Public Health, icddr,b, TREND Ghana, Kumasi Metropolitan Assembly, World Bank

Workshop Background

Recent trends in urbanization and changing population dynamics have led to a dramatic rise in populations living in urban areas throughout Africa and Asia. These urbanizing populations settle in areas in which water, sanitation and hygiene systems are already overburdened, and many live in unplanned or illegal urban or peri-urban settlements. Rapid urbanization has outpaced sanitation services and fecal sludge management (FSM) in many cities in South Asia and Sub-Saharan Africa leading to gaps in FSM along the sanitation value chain. Shit Flow Diagrams have highlighted the points where unsafely-managed fecal waste enters the environment, but equally important is understanding where this waste ends up and the public health risks associated with its unsafe management. Sanitation decision-makers currently have a number of tools at their disposal to increase the availability and accessibility of data to support evidence-based decision-making. However, there are few opportunities to share the results of these tools and how they have been, and can be, used to influence sanitation investment, policies, and decision -making practices. This workshop allowed participants to learn about the approaches, successes, and challenges of organizations who aimed to utilize public health data in urban sanitation decision-making and to engage with fellow participants on ways to improve evidence-based decision-making in the sanitation sector. The convening organizations have all utilized the SaniPath Exposure Assessment Tool to understand exposure to fecal contamination in urban and peri-urban areas and shared their experience using this tool in the framework of factors that influence decision-making.

Wordcloud of discussion topics from workshop notes

Access Workshop Presentations Here Access Workshop Report Here