Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh

Ercumen, Ayse ; Pickering, Amy J. ; Kwong, Laura H. ; Mertens, Andrew ; Arnold, Benjamin F. ; Benjamin-Chung, Jade ; Hubbard, Alan E. ; Alam, Mahfuja ; Sen, Debashis ; Islam, Sharmin ; Rahman, Mohamed Zahidur ; Kullmann, Craig ; Chase, Claire ; Ahmed, Rokeya ; Parvez, Sarker Masud ; Unicomb, Leanne ; Rahman, Mahbubur ; Ram, Pavani K. ; Clasen, Thomas ; Luby, Stephen P. ; Colford, John M., Jr.

American Chemical Society

关键词: WATER AND SANITATION;    DRINKING WATER;    RANDOMIZED CONTROL TRIAL;    ENVIRONMENTAL CONTAMINATION;    WATER TREATMENT;   

DOI  :  10.1021/acs.est.8b02988
RP-ID  :  136139

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial’s control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog10 = −0.88 (−1.01, −0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.