Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) an...

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Main Authors:	Ercumen, Ayse, Pickering, Amy J., Kwong, Laura H., Mertens, Andrew, Arnold, Benjamin F., Benjamin-Chung, Jade, Hubbard, Alan E., Alam, Mahfuja, Sen, Debashis, Islam, Sharmin, Rahman, Mohamed Zahidur, Kullmann, Craig, Chase, Claire, Ahmed, Rokeya, Parvez, Sarker Masud, Unicomb, Leanne, Rahman, Mahbubur, Ram, Pavani K., Clasen, Thomas, Luby, Stephen P., Colford, John M., Jr.
Format:	Journal Article
Published:	American Chemical Society 2019
Subjects:	WATER AND SANITATION DRINKING WATER RANDOMIZED CONTROL TRIAL ENVIRONMENTAL CONTAMINATION WATER TREATMENT HANDWASHING
Online Access:	http://hdl.handle.net/10986/31345

id	okr-10986-31345
recordtype	oai_dc
spelling	okr-10986-313452021-05-25T10:54:36Z Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh Ercumen, Ayse Pickering, Amy J. Kwong, Laura H. Mertens, Andrew Arnold, Benjamin F. Benjamin-Chung, Jade Hubbard, Alan E. Alam, Mahfuja Sen, Debashis Islam, Sharmin Rahman, Mohamed Zahidur Kullmann, Craig Chase, Claire Ahmed, Rokeya Parvez, Sarker Masud Unicomb, Leanne Rahman, Mahbubur Ram, Pavani K. Clasen, Thomas Luby, Stephen P. Colford, John M., Jr. WATER AND SANITATION DRINKING WATER RANDOMIZED CONTROL TRIAL ENVIRONMENTAL CONTAMINATION WATER TREATMENT HANDWASHING Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial’s control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog10 = −0.88 (−1.01, −0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination. 2019-03-05T22:13:25Z 2019-03-05T22:13:25Z 2018-09-26 Journal Article Environmental Science and Technology http://hdl.handle.net/10986/31345 CC BY 4.0 http://creativecommons.org/licenses/by/4.0 World Bank American Chemical Society Publications & Research :: Journal Article Publications & Research South Asia Bangladesh
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
topic	WATER AND SANITATION DRINKING WATER RANDOMIZED CONTROL TRIAL ENVIRONMENTAL CONTAMINATION WATER TREATMENT HANDWASHING
spellingShingle	WATER AND SANITATION DRINKING WATER RANDOMIZED CONTROL TRIAL ENVIRONMENTAL CONTAMINATION WATER TREATMENT HANDWASHING Ercumen, Ayse Pickering, Amy J. Kwong, Laura H. Mertens, Andrew Arnold, Benjamin F. Benjamin-Chung, Jade Hubbard, Alan E. Alam, Mahfuja Sen, Debashis Islam, Sharmin Rahman, Mohamed Zahidur Kullmann, Craig Chase, Claire Ahmed, Rokeya Parvez, Sarker Masud Unicomb, Leanne Rahman, Mahbubur Ram, Pavani K. Clasen, Thomas Luby, Stephen P. Colford, John M., Jr. Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
geographic_facet	South Asia Bangladesh
description	Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial’s control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog10 = −0.88 (−1.01, −0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.
format	Journal Article
author	Ercumen, Ayse Pickering, Amy J. Kwong, Laura H. Mertens, Andrew Arnold, Benjamin F. Benjamin-Chung, Jade Hubbard, Alan E. Alam, Mahfuja Sen, Debashis Islam, Sharmin Rahman, Mohamed Zahidur Kullmann, Craig Chase, Claire Ahmed, Rokeya Parvez, Sarker Masud Unicomb, Leanne Rahman, Mahbubur Ram, Pavani K. Clasen, Thomas Luby, Stephen P. Colford, John M., Jr.
author_facet	Ercumen, Ayse Pickering, Amy J. Kwong, Laura H. Mertens, Andrew Arnold, Benjamin F. Benjamin-Chung, Jade Hubbard, Alan E. Alam, Mahfuja Sen, Debashis Islam, Sharmin Rahman, Mohamed Zahidur Kullmann, Craig Chase, Claire Ahmed, Rokeya Parvez, Sarker Masud Unicomb, Leanne Rahman, Mahbubur Ram, Pavani K. Clasen, Thomas Luby, Stephen P. Colford, John M., Jr.
author_sort	Ercumen, Ayse
title	Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
title_short	Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
title_full	Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
title_fullStr	Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
title_full_unstemmed	Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh
title_sort	do sanitation improvements reduce fecal contamination of water, hands, food, soil, and flies? evidence from a cluster-randomized controlled trial in rural bangladesh
publisher	American Chemical Society
publishDate	2019
url	http://hdl.handle.net/10986/31345
_version_	1764474115498967040

Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh

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