Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making

Foster, Tim; Falletta, Jay; Amin, Nuhu; Rahman, Mahbubur; Liu, Pengbo; Raj, Suraja; Mills, Freya; Petterson, Susan; Norman, Guy; Moe, Christine L.; Willetts, Juliet

doi:10.1016/j.ijheh.2020.113669

Cited by 31 publications

(19 citation statements)

References 72 publications

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“…Most of the three-septic-tank types were constructed privately and it is difficult to say whether they were designed and operated properly, and whether there were risks to human health. Prior research indicates a high concentration of pathogens in sludge from septic tanks ( Foster et al, 2021 ; Peal et al, 2020 ; Amin et al, 2020 ; Mills et al, 2018 ). We found cases in which the third compartment was very large, so that the ratio of the three compartments was not 2:1:3, to reduce the frequency of emptying.…”

Section: Resultsmentioning

confidence: 99%

Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

Guo

Zhou

Simha

et al. 2021

Science of The Total Environment

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The ongoing Toilet Revolution in China offers an opportunity to improve sanitation in rural areas by introducing new approaches, such as urine source separation, that can contribute to achieving SDG6. However, few studies have systematically assessed the social acceptability of managing human excreta collected in new sanitation systems. Therefore, in this study we performed face-to-face interviews with 414 local residents from 13 villages across three provinces in western China, to analyze the current situation and attitudes to possible changes in the rural sanitation service chain. We found that the sanitation chain was predominantly pit latrine-based, with 86.2% of households surveyed collecting their excreta in a simple pit, 82% manually emptying their pits, and 80.2% reusing excreta in agriculture without adequate pre-treatment. A majority (72%) of the households had a generally positive attitude to production of human excreta-derived fertilizer, but only 24% agreed that urine and feces should be collected separately. Multivariate logistic regression indicated that three factors (level of education, number of permanent household residents, perceived social acceptability) significantly influenced respondents' attitudes to reuse of excreta, although only perceived social acceptability had a high strength of association. Overall, our survey revealed that rural households often misuse toilet systems, fail to comply with government-specified sanitation guidelines, have low awareness of alternative solutions, and are over-reliant on the government to fix problems in the service chain. Thus while new sanitation technologies should be developed and implemented, information campaigns that encourage rural households to manage their excreta safely are also important.

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Section: Resultsmentioning

confidence: 99%

Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

Guo

Zhou

Simha

et al. 2021

Science of The Total Environment

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“…8,9,71–76 ESBL- E. coli have also been identified in surface water 77 and wastewater in urban areas 78,79 , posing risks to people - including children - who interact with open drains or are exposed to water from sewage overflows. 80 Environmental interventions targeting a single route of exposure, even one that is responsible for a substantial portion of enteric pathogen transmission, may be insufficient to combat AMR transmission in regions of high AMR prevalence and multiple concurrent exposure routes. Improved understanding of AMR exposure routes, inclusive interfaces among animals, people, and the environment (“One Health”), may elucidate potential for multimodal interventions beyond in-line chlorination alone to reduce ESBL- E. coli carriage.…”

Section: Discussionmentioning

confidence: 99%

Drinking water chlorination impact on fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Bangladeshi children in a double-blind, cluster-randomized controlled trial

Montealegre¹,

Greenwood²,

Teichmann³

et al. 2022

Preprint

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Background Water, sanitation, and hygiene (WASH) services have the potential to interrupt transmission of antimicrobial-resistant bacteria and reduce the need for antibiotics, thereby reducing selection for resistance. However, evidence of WASH impacts on antimicrobial resistance (AMR) is lacking. Methods We evaluated extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and ESBL-KESC (Klebsiella spp., Enterobacter spp., Serratia spp., and Citrobacter spp.) carriage in the feces of 479 Bangladeshi children under 5 years of age enrolled in a double-blind, cluster-randomized controlled trial of in-line drinking water chlorination in two low-income urban communities in Bangladesh. We additionally assessed the interventions impact on circulating beta-lactamase genes in fecal metagenomes and in genomes of fecal ESBL-E. coli isolates. Findings We detected ESBL-E. coli in 65% (n = 309) and ESBL-KESC in 12% (n = 56) of enrolled children. We observed no effect of the intervention on the prevalence of ESBL-E. coli (relative risk [95% confidence interval] = 0.98 [0.78, 1.23]) when controlling for study site and age. Although ESBL-KESC ( 0.76 [0.44, 1.29]) was lower among children in the intervention group, the relative risk was not significant. Concentrations of ESBL-E. coli (log10 CFU/g-wet) were on average [95% confidence interval] 0.13 [-0.16, 0.42] higher in the intervention group and ESBL-KESC (log10 CFU/g-wet) were 0.10 [-0.22, 0.02], lower in the intervention group, when controlling for study site and age. Furthermore, the distribution of ESBL-E.coli sequence types, type of beta-lactamase-encoding genes in ESBL-E. coli isolates, and the presence and relative abundance of beta-lactamase-encoding genes in childrens fecal metagenomes did not differ significantly between the intervention and control children. Interpretation One year of in-line drinking water chlorination in communities did not meaningfully impact the carriage of ESBL-E. coli among children in an area of high ESBL-E. coli carriage. While ESBL-KESC was at lower prevalence than ESBL-E. coli, in the intervention group, limited study power prevented a clear interpretation of treatment effect. Development and evaluation of effective interventions to reduce AMR carriage are needed to support calls for WASH embedded in current National and Global AMR Action Plans.

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“…Wastewater collected from the WaterHub water reclamation facility on the Emory University campus between April 2019 and July 2020 were used for the Moore swab and UF methods development and validation studies in Atlanta. From April to October 2019, drain and canal water samples were collected in Mirpur, Dhaka, Bangladesh, a densely populated low-income area where residents live in compounds containing multiple families and the incidence of ST and SPA is high (Amin et al, 2020;Foster et al, 2021). Large volume (20 L) samples were collected and concentrated by UF as described below.…”

Section: Study Sites and Environmental Sample Collectionmentioning

confidence: 99%

Development of Moore Swab and Ultrafiltration Concentration and Detection Methods for Salmonella Typhi and Salmonella Paratyphi A in Wastewater and Application in Kolkata, India and Dhaka, Bangladesh

et al. 2021

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Enteric fever is a severe systemic infection caused by Salmonella enterica serovar Typhi (ST) and Salmonella enterica serovar Paratyphi A (SPA). Detection of ST and SPA in wastewater can be used as a surveillance strategy to determine burden of infection and identify priority areas for water, sanitation, and hygiene interventions and vaccination campaigns. However, sensitive and specific detection of ST and SPA in environmental samples has been challenging. In this study, we developed and validated two methods for concentrating and detecting ST/SPA from wastewater: the Moore swab trap method for qualitative results, and ultrafiltration (UF) for sensitive quantitative detection, coupled with qPCR. We then applied these methods for ST and SPA wastewater surveillance in Kolkata, India and Dhaka, Bangladesh, two enteric fever endemic areas. The qPCR assays had a limit of detection of 17 equivalent genome copies (EGC) for ST and 25 EGC for SPA with good reproducibility. In seeded trials, the Moore swab method had a limit of detection of approximately 0.05–0.005 cfu/mL for both ST and SPA. In 53 Moore swab samples collected from three Kolkata pumping stations between September 2019 and March 2020, ST was detected in 69.8% and SPA was detected in 20.8%. Analysis of sewage samples seeded with known amount of ST and SPA and concentrated via the UF method, followed by polyethylene glycol precipitation and qPCR detection demonstrated that UF can effectively recover approximately 8, 5, and 3 log10 cfu of seeded ST and SPA in 5, 10, and 20 L of wastewater. Using the UF method in Dhaka, ST was detected in 26.7% (8/30) of 20 L drain samples with a range of 0.11–2.10 log10 EGC per 100 mL and 100% (4/4) of 20 L canal samples with a range of 1.02–2.02 log10 EGC per 100 mL. These results indicate that the Moore swab and UF methods provide sensitive presence/absence and quantitative detection of ST/SPA in wastewater samples.

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Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making

Cited by 31 publications

References 72 publications

Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

Drinking water chlorination impact on fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Bangladeshi children in a double-blind, cluster-randomized controlled trial

Development of Moore Swab and Ultrafiltration Concentration and Detection Methods for Salmonella Typhi and Salmonella Paratyphi A in Wastewater and Application in Kolkata, India and Dhaka, Bangladesh

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