A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

Abstract

We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6-24 months in rural Bangladesh. We defined "basic" sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: -0.31 log colony forming units [CFU]/toy ball; 95% confidence interval [CI]: -0.61, -0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: -0.38 log CFU/toy ball; 95% CI: -0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households.

Effects of Single and Combined Water, Sanitation and Handwashing Interventions on Fecal Contamination in the Domestic Environment: A Cluster-Randomized Controlled Trial in Rural Bangladesh

“… 23 Our findings differ from two studies in rural Bangladesh that found fewer fecal coliforms on sentinel toys in compounds with better water, sanitation and hygiene infrastructure. 26 , 27 However, these studies used cross-sectional designs susceptible to confounding; compounds with improved sanitary conditions could have other characteristics leading to reduced contamination. Toy balls in our study were often coated in soil; the lack of E. coli reduction on toys is consistent with the lack of intervention impact on E. coli in soil in our previous assessment.…”

“… 24 , 25 They serve as a measure of overall contamination of domestic surfaces and objects, and have been shown to distinguish households with vs without improved water, sanitation, and hygiene conditions in Bangladesh. 26 , 27 In single intervention arms, we only collected a relevant subset of sample types expected to be directly affected by the interventions; we sampled drinking water and (in year two) children’s food in the water arm, and index child hands and (in year two) children’s food in the handwashing arm. Additionally, field staff examined caregiver and index child hands (fingernails, fingerpads and palms) in the control, handwashing and WSH arms for visible dirt; observed dirt on hands has been validated as a proxy for handwashing 28 and shown to correlate with bacterial counts on hands.…”

Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh

“…Characteristics of the target households have been presented in more detail elsewhere. 23 Almost half of the target households (n = 204, 48%) were from neighborhoods with no improved sanitation access. Seven percent of the target households (n = 29) were from * Here data on all NHs are presented without considering the study design element † Here, data are presented considering the study design.…”

“…The enumerators systematically selected 454 target households with a child aged 6-24 months, from a simple random sample of villages enrolled for a health impact study as described elsewhere. 23 The youngest child aged 6-24 months of age in the target household was considered as the target child. All NHs within a 20-m radius of the entrance to the living room of each target household were enrolled in this study.…”

“…Neighborhood and target household data were collected by enumerators that used a verbally administered, structured questionnaire and spot-check observations on household possessions; water, sanitation, and hygiene-related behavior and facilities in target households. 23 Enumerators used a shorter version of this procedure to collect information about human and animal feces disposal practices in the NHs. Data were recorded using a tablet computer.…”