Micro-Space Complexity and Context in the Space-Time Variation in Enteric Disease Risk for Three Informal Settlements of Port au Prince, Haiti.

Mohammed Rashid,Vanessa Rouzier,Andrew Curtis,Jean Pape,Md Alam,John Morris, Jr,Jayakrishnan Ajayakumar,Robert Squires,Sandra Bempah,Meer Taifur Alam,Afsar Ali

doi:10.3390/ijerph16050807

Abstract

Diffusion of cholera and other diarrheal diseases in an informal settlement is a product of multiple behavioral, environmental and spatial risk factors. One of the most important components is the spatial interconnections among water points, drainage ditches, toilets and the intervening environment. This risk is also longitudinal and variable as water points fluctuate in relation to bacterial contamination. In this paper we consider part of this micro space complexity for three informal settlements in Port au Prince, Haiti. We expand on more typical epidemiological analysis of fecal coliforms at water points, drainage ditches and ocean sites by considering the importance of single point location fluctuation coupled with recording micro-space environmental conditions around each sample site. Results show that spatial variation in enteric disease risk occurs within neighborhoods, and that while certain trends are evident, the degree of individual site fluctuation should question the utility of both cross-sectional and more aggregate analysis. Various factors increase the counts of fecal coliform present, including the type of water point, how water was stored at that water point, and the proximity of the water point to local drainage. Some locations fluctuated considerably between being safe and unsafe on a monthly basis. Next steps to form a more comprehensive contextualized understanding of enteric disease risk in these environments should include the addition of behavioral factors and local insight.

Highlights

Monitoring the water supply for diarrheal pathogens in informal settlements (IS) is imperative to improve the health of residents while being imperative in achieving the targets set out in the United Nations’ Millennium Development Goals [1,2,3,4]
Water sampling at thirty-eight test sites began in October 2016 and spatial video (SV) environmental and the implications these results have for neighborhood residents, the results of the monthly data assessments commenced in February 2017
In order to tease out the spatial and temporal variation collection trips are presented in two ways: firstly as a fecal coliform (FC) comparative table for just household water between sites and the implications these results have for neighborhood residents, the results of the points and as a combined FC—environmental assessment

Summary

Introduction

Monitoring the water supply for diarrheal pathogens in informal settlements (IS) is imperative to improve the health of residents while being imperative in achieving the targets set out in the United Nations’ Millennium Development Goals [1,2,3,4]. During the cholera epidemic the group established an emergency cholera treatment center, and developed comprehensive disease reduction strategies including providing chlorinated water, building of latrines, and establishing rehydration posts, a 250-bed tent hospital, and 10 community health posts). Two of these communities, along with a third unvaccinated neighborhood, are the setting of the study described here. The environmental and coliform bacterial data collection described in this paper is part of an initiative to compare and contrast the long-term effectiveness of the original vaccination campaign, while at the same time providing a more detailed understanding of ongoing diarrheal disease risk in the neighborhoods [19]

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Discussion

Conclusion