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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Moe, Christine L
Raj, Suraja J
Baker, Kelly K
Robb, Katharine A
Ampofo, Joseph A
Freeman, Matthew C
Reese, Heather E
Teunis, Peter F M
MetadataShow full item record
TitleMultipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach.
Published inAm J Trop Med Hyg 2017; 97(4):1009-19
PubliekssamenvattingLack 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.
- Assessment of Fecal Exposure Pathways in Low-Income Urban Neighborhoods in Accra, Ghana: Rationale, Design, Methods, and Key Findings of the SaniPath Study.
- Authors: Robb K, Null C, Teunis P, Yakubu H, Armah G, Moe CL
- Issue date: 2017 Oct
- The SaniPath Exposure Assessment Tool: A quantitative approach for assessing exposure to fecal contamination through multiple pathways in low resource urban settlements.
- Authors: Raj SJ, Wang Y, Yakubu H, Robb K, Siesel C, Green J, Kirby A, Mairinger W, Michiel J, Null C, Perez E, Roguski K, Moe CL
- Issue date: 2020
- Children Are Exposed to Fecal Contamination via Multiple Interconnected Pathways: A Network Model for Exposure Assessment.
- Authors: Wang Y, Moe CL, Teunis PFM
- Issue date: 2018 Nov
- Variation in E. coli concentrations in open drains across neighborhoods in Accra, Ghana: The influence of onsite sanitation coverage and interconnectedness of urban environments.
- Authors: Berendes DM, de Mondesert L, Kirby AE, Yakubu H, Adomako L, Michiel J, Raj S, Robb K, Wang Y, Doe B, Ampofo J, Moe CL
- Issue date: 2020 Mar
- Quantifying Contact with the Environment: Behaviors of Young Children in Accra, Ghana.
- Authors: Teunis PFM, Reese HE, Null C, Yakubu H, Moe CL
- Issue date: 2016 Apr