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The Role of Toilets, FSM, and Flooding on Enteric Infection in Children in Vellore, India

D Berendes, J Leon, A Kirby, J Clennon, S Raj, H Yakubu, K Robb, A Kartikeyan, P Hemavathy, A Gunasekaran, S Roy, B Ghale, J Kumar, V Mohan, G Kang, CL Moe

During the 4th International Faecal Sludge Management Conference, David Berendes presented the findings from a study that examined household and neighborhood environmental factors which contribute to pediatric enteric infection risk. The key lessons learned from this study are: it is imperative that homes with tanks that discharge directly to open drains plan for fecal sludge containment during rainy seasons, and that low coverage of household toilets combined with prevalent open drains may increase the risk of enteric infection among children.

This five-year study conducted within a single, low-income, urban neighborhood in India looked at whether the presence of household toilets, the type of fecal sludge management associated with a toilet (e.g. toilets discharging to an open drain versus ones containing feces onsite), and the presence of flooding in the neighborhood influenced the risk that a young infant will acquire an enteric disease.

To do this, the researchers collected and tested stool samples, assessed spatial data, and conducted household caregiver interviews. After collecting and testing diarrheal and monthly stool samples from 230 children for enteric pathogens, and examining 100 household caregiver interviews, they found that 82% of the 33% of households that had a toilet had toilets that discharged to open drains. Although the presence of a toilet that discharged to an open drain reduced the risk of enteric infection during the dry season, Berendes and his colleagues discovered that this protective effect vanished during the monsoon season. They also found that drain flooding was associated with significantly higher risk of infection during the monsoon season, and that low toilet coverage within a neighborhood can create downstream negative effects. Given these results, planners should be wary of the setup of toilets to ensure that the benefits of toilets are not nullified due to flooding.

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