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    Multipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach.

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    Authors
    Wang, Yuke
    Moe, Christine L
    Null, Clair
    Raj, Suraja J
    Baker, Kelly K
    Robb, Katharine A
    Yakubu, Habib
    Ampofo, Joseph A
    Wellington, Nii
    Freeman, Matthew C
    Armah, George
    Reese, Heather E
    Peprah, Dorothy
    Teunis, Peter F M
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    Type
    Article
    Language
    en
    
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    Title
    Multipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach.
    Published in
    Am J Trop Med Hyg 2017; 97(4):1009-19
    Publiekssamenvatting
    Lack of adequate sanitation results in fecal contamination of the environment and poses a risk of disease transmission via multiple exposure pathways. To better understand how eight different sources contribute to overall exposure to fecal contamination, we quantified exposure through multiple pathways for children under 5 years old in four high-density, low-income, urban neighborhoods in Accra, Ghana. We collected more than 500 hours of structured observation of behaviors of 156 children, 800 household surveys, and 1,855 environmental samples. Data were analyzed using Bayesian models, estimating the environmental and behavioral factors associated with exposure to fecal contamination. These estimates were applied in exposure models simulating sequences of behaviors and transfers of fecal indicators. This approach allows us to identify the contribution of any sources of fecal contamination in the environment to child exposure and use dynamic fecal microbe transfer networks to track fecal indicators from the environment to oral ingestion. The contributions of different sources to exposure were categorized into four types (high/low by dose and frequency), as a basis for ranking pathways by the potential to reduce exposure. Although we observed variation in estimated exposure (108-1016 CFU/day for Escherichia coli) between different age groups and neighborhoods, the greatest contribution was consistently from food (contributing > 99.9% to total exposure). Hands played a pivotal role in fecal microbe transfer, linking environmental sources to oral ingestion. The fecal microbe transfer network constructed here provides a systematic approach to study the complex interaction between contaminated environment and human behavior on exposure to fecal contamination.
    DOI
    10.4269/ajtmh.16-0408
    PMID
    29031283
    URI
    http://hdl.handle.net/10029/621376
    ae974a485f413a2113503eed53cd6c53
    10.4269/ajtmh.16-0408
    Scopus Count
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