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The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study.

ABSTRACT: Epidemiological studies have identified an increased risk of diarrheal diseases associated with using shared sanitation facilities. We hypothesized that this might be related to differences in transmission routes of pathogens. We proposed a mathematical model of two fictitious pathogens, one transmitted with an environmental reservoir and one without. We assumed that individuals susceptible to one pathogen are not susceptible to the other, and therefore, decoupled the two models. We initialized the model with 99% individuals being susceptible. We sampled the parameter space using Latin Hypercube Sampling. We simulated 10,000 parameter sets. We varied the effective shared sanitation coverage (the product of latrine coverage and users' compliance). Our results show that, in our hypothetical scenario, across all levels of effective coverage of shared sanitation, the median final cumulative incidence of diarrheal disease was higher than that of zero coverage. Our simulation findings suggest that increasing effective coverage of shared sanitation may have limited benefits against diarrhea-causing pathogens with an environmental reservoir and may lack benefit against diarrhea-causing pathogens without an environmental reservoir given increased human contacts if latrines are poorly maintained.

SUBMITTER: Just MR

PROVIDER: S-EPMC6147076 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study.

Just Matthew R MR Carden Stephen W SW Li Sheng S Baker Kelly K KK Gambhir Manoj M Fung Isaac Chun-Hai IC

Pathogens and global health 20180606 4

Epidemiological studies have identified an increased risk of diarrheal diseases associated with using shared sanitation facilities. We hypothesized that this might be related to differences in transmission routes of pathogens. We proposed a mathematical model of two fictitious pathogens, one transmitted with an environmental reservoir and one without. We assumed that individuals susceptible to one pathogen are not susceptible to the other, and therefore, decoupled the two models. We initialized ...[more]

PMID: 29874978

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Project description:Health risks associated with poor sanitation behaviours continue to be reported mostly from low-income countries (LICs). Reports show that various factors limit many people from accessing and using improved latrines, forcing some to opt for sharing latrines with neighbours, others practicing open defecation. Meanwhile, debate prevails on whether shared latrines should be categorised as unimproved according to WHO/UNICEF-JMP criteria. We contribute to this debate based on results from a study undertaken in three regions, Tanzania.Data were collected through observations in 1,751 households with latrines, coupled with collection of opinions from heads of such households regarding the latrine-sharing practices. Bivariate and multivariate logistic regression analyses were performed to assess associations between the outcome and possible predictor variables.Of all 1,751 latrines, 14.6% were shared. Among the shared latrines, 74.2% were found being generally clean as compared to 69.2% of the non-shared ones. Comparing the shared and non-shared latrines, the non-shared latrines were significantly less likely to be found with floors built with permanent materials (OR = 0.73, 95% CI: 0.55, 0.98); washable floors (OR = 0.69; 95% CI: 0.51, 0.93); and lockable doors (OR = 0.73; 95% CI: 0.56, 0.95). Shared latrines were less likely to have floors with faecal matter, functional handwashing facilities (HWFs), HWFs with running water, and roofs; albeit the differences in all these scenarios were not statistically significant. Respondents expressed desire for improved latrines, but also did not find it wrong to share latrines if cleanliness was maintained.Having an 'improved' latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as 'improved'. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important.

Project description:WHO and UNICEF have proposed an action plan to achieve universal water, sanitation and hygiene (WASH) coverage in healthcare facilities (HCFs) by 2030. The WASH targets and indicators for HCFs include: an improved water source on the premises accessible to all users, basic sanitation facilities, a hand washing facility with soap and water at all sanitation facilities and patient care areas. To establish viable targets for WASH in HCFs, investigation beyond 'access' is needed to address the state of WASH infrastructure and service provision. Patient and caregiver use of WASH services is largely unaddressed in previous studies despite being critical for infection control.The state of WASH services used by staff, patients and caregivers was assessed in 17 rural HCFs in Rwanda. Site selection was non-random and predicated upon piped water and power supply. Direct observation and semi-structured interviews assessed drinking water treatment, presence and condition of sanitation facilities, provision of soap and water, and WASH-related maintenance and record keeping. Samples were collected from water sources and treated drinking water containers and analyzed for total coliforms, E. coli, and chlorine residual.Drinking water treatment was reported at 15 of 17 sites. Three of 18 drinking water samples collected met the WHO guideline for free chlorine residual of >0.2 mg/l, 6 of 16 drinking water samples analyzed for total coliforms met the WHO guideline of <1 coliform/100 mL and 15 of 16 drinking water samples analyzed for E. coli met the WHO guideline of <1 E. coli/100 mL. HCF staff reported treating up to 20 L of drinking water per day. At all sites, 60% of water access points (160 of 267) were observed to be functional, 32% of hand washing locations (46 of 142) had water and soap and 44% of sanitary facilities (48 of 109) were in hygienic condition and accessible to patients. Regular maintenance of WASH infrastructure consisted of cleaning; no HCF had on-site capacity for performing repairs. Quarterly evaluations of HCFs for Rwanda's Performance Based Financing system included WASH indicators.All HCFs met national policies for water access, but WHO guidelines for environmental standards including water quality were not fully satisfied. Access to WASH services at the HCFs differed between staff and patients and caregivers.

Dataset Information

The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study.

Publications

The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study.

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