Abstract
Diarrheal illnesses from enteric pathogens are a leading cause of death in children under five in low- and middle-income countries (LMICs). Sanitation is one way to reduce the spread of enteric pathogens in the environment; however, few studies have investigated the effectiveness of sanitation in rural LMICs in reducing pathogens in the environment. In this study, we measured the impact of a sanitation intervention (dual-pit latrines, sani-scoops, child potties delivered as part of a randomized control trial, WASH Benefits) in rural Bangladeshi household compounds by assessing prevalence ratios, differences, and changes in the concentration of pathogen genes and host-specific fecal markers. We found no difference in the prevalence of pathogenic Escherichia coli, norovirus, or Giardia genes in the domestic environment in the sanitation and control arms. The prevalence of the human fecal marker was lower on child hands and the concentration of animal fecal marker was lower on mother hands in the sanitation arm in adjusted models, but these associations were not significant after correcting for multiple comparisons. In the subset of households with ≥10 individuals per compound, the prevalence of enterotoxigenic E. coli genes on child hands was lower in the sanitation arm. Incomplete removal of child and animal feces or the compound (versus community-wide) scale of intervention could explain the limited impacts of improved sanitation.
Highlights
Deaths due to diarrheal illnesses in children under five are decreasing, yet the rate remains high.[1]
On child hands in both study arms, the most prevalent E. coli virulence gene (ECVG) was stx1/2 (control (C): 13.4%; sanitation (S): 16.8 (11.2, 22.5)%)
It is possible that some of the fecal contamination in stored drinking water originated from the source water, as other studies have found indicators of fecal contamination and pathogen genes in these sources.[31−34] Another possible mechanism of stored water contamination is through contact with hands,[35−37] which we have shown to be contaminated with multiple types of pathogenic E. coli virulence genes (Figure 1)
Summary
Deaths due to diarrheal illnesses in children under five are decreasing, yet the rate remains high.[1] In South Asia, approximately 10% of all deaths in children under five are due to diarrhea.[2] These illnesses result from the transmission of enteric pathogens facilitated by inadequate drinking water, sanitation, and hygiene (WASH) conditions. Pathogens can be transmitted from the feces of an infected host to a new host through the fecal-oral route, mediated through environmental reservoirs.[3] transmission can occur through exposure to contaminated water, soil, hands, fomites, vectors (e.g., flies), and food. Sanitation infrastructure, and hygiene interventions use different mechanisms to block these exposure pathways. Sanitation has the potential to block the most upstream fecal-oral transmission pathways by isolating and preventing the spread of feces through soil, water, and flies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
