Assessing sanitation pathways for better WASH service delivery

1. Assessment of Fecal Exposure Pathways in
Low-Income Urban Settings
Mole 23rd Conference
August 24, 2012

2. Study Goals
This project consists of an in-depth, multi-disciplinary
assessment of exposure to human fecal contamination in low-
income neighborhoods of Accra.
• Address the scarcity of data available to
sanitation policy makers and implementers
– Identify and describe:
• Sources and movement of human fecal contamination in
low-income urban environment
• Behavior of adults and children that leads to exposure to
various fecal contamination pathways
– Use new certified tools and approaches to determine
which exposure pathways pose the greatest risk

3. Multiple Fecal Exposure Pathways
Hands
Flies Food
Soil
Drinking Water
Surface Water Slide courtesy of Dr. Karen Levy

4. Which Pathway Poses the Greatest Risk??
Household

5. Study Phases
• 4 year study made up of 2 phases
• Phase 1:
– 15 months (Sept 2011- Dec 2012)
• First of its kind
• 4 study neighborhoods
• Multi-disciplinary approach to assess human behavior and
environmental contamination in urban Accra
• Phase 1.5:
– Jan 2013 – June 2013: Data analysis and development of
rapid assessment tools
• Phase 2: (July 2013- June 2014)- Extend and validate
results of phase 1 and apply rapid assessment tools in a
new context

6. Environmental Sampling and
Behavior Observation

15. Environmental sampling progress to
date
Sample type Number collected
Swabs 158
Handrinse 260
Particulate (Sand, soil and 191
sediments)
Septage 3
Food 93
Stored HH and school water 125
,sachet water
Piped water and Ocean Water 90
Flies 48
Drains 76
Total samples 1044

16. E. Coli results
Type N % positive
Piped water 66 33.3%
Drinking water (HH and schools) 117 46.2%
Sea water 18 100%
Drain water 55 96%
Flood water 19 73.7%
Produce 97 83.5%
Soil, sand, sediment 183 90.7%
Swabs 142 67%
Flies 32 100%
Sewage 3 100%
Hand rinses 238 86.5%
Sachet rinses 36 22.2%
Total 938

17. Behavioral study progress to date
• 16 Focus Group Discussions
• 12 Key Informant Interviews
• 39 Child behavior observations
• 11 Beach observations
• 25 Nurseries and 27 Primary School observations
• 32 Public Latrine observations
• 15 Drain observation
• 146 Latrine exit interviews

18. Household Conditions Survey (n=89)
Respondent status 69.6% F in HH
Tenancy 57% own
Compound or HH 68.8% compound
Business in HH 53.1% yes
Drinking water source 75.6% sachet
Latrine in HH 9 with access
Number of HH sharing latrine 4 share with other HH
Where ppl 5-12 yrs defecate 41.8% public latrine
Where youngest child defecates 44.8% diaper/nappy
Child age <2 years average
Child feces disposal 58.4% rubbish
Other HHs leave child feces on ground 64.4% no
Child had diarrhea (2 wks) 50.6% yes
Ever de-wormed child 41.2% yes
Latrine type 88.9% none
Animals in compound 64% yes
Children Under 5 Observations
• 39 children observed
• Behavior events per child: 16.1(6-28)
• 40 caregivers observed
• Behavior events per caregiver: 3.4(1-10)

19. Upcoming study activities
• 600 Household Surveys linked with
environmental sampling in all 4 communities
starting next week
• Agricultural focused study starting in mid –
September, 2012
• Full data analysis for development of rapid
assessment tools and planning for phase 2