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

• Published in: Environmental science & technology 2018-11, Vol.52 (21), p.12089-12097
• 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, Md. 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
• Format: Article
• Language: English
• Subjects: Animals; Bangladesh; Child; Child, Preschool; Children; Clinical trials; Cluster analysis; Combined water; Contamination; Defecation; Diptera; drinking; Drinking water; E coli; Environment; Escherichia coli; Escherichia coli Infections - prevention & control; Fecal coliforms; Feces; Food; Food contamination; Hand Disinfection; hand washing; hands; Households; Humans; indicator species; Intervention; Nutrition; nutritional intervention; pathogens; Randomization; randomized clinical trials; Rural areas; Sanitation; Sediment pollution; Soil; Soil contamination; Soil water storage; Water pollution; Water treatment
• ISSN: 0013-936X; 1520-5851; 1520-5851
• DOI: 10.1021/acs.est.8b02988

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.