Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana.
In low-income countries, rapid urbanization adds pressure to already stressed water and sanitation systems that are critical to the health of communities. Drainage networks, designed for stormwater but commonly used for disposing of waste, are rarely covered completely, allowing residents to easily come into contact with their contents. This study used spatial mapping, documentation of physical drain characteristics, microbiological analysis of drain samples, and behavioral observation to comprehensively examine drains as a route of exposure to fecal contamination in four low-income neighborhoods in Accra, Ghana. A stochastic model of six likely exposure scenarios was constructed to estimate children's exposure to drain water. Regardless of the age of the child, any exposure scenario considered resulted in exposure to a high level of fecal contamination. Fecal contamination levels in drains were high (Escherichia coli: geometric mean (GM), 8.60 cfu log(10)/100 mL; coliphage: GM, 5.56 pfu log(10)/100 mL), and did not differ by neighborhood or physical drain characteristics, indicating that frequency of contact with drains, and not drain type or location, drives exposure risk. To mitigate health risks associated with this exposure, drains should be covered, with priority given to large concrete and small to medium dirt-lined drains that children were most commonly observed entering.
Center for Global Safe Water, Department of Epidemiology, Emory University, Atlanta, GA, USA.
Stephanie R
SR
Gretsch
Council for Scientific and Industrial Research, Water Research Institute, Accra, Ghana.
Joseph A
JA
Ampofo
Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA; Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA.
Kelly K
KK
Baker
Center for Global Safe Water, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
Julie
J
Clennon
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu; Mathematica Policy Research, Princeton, NJ, USA; Radcliffe Institute for Advanced Study, Cambridge, MA, USA.
Clair A
CA
Null
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu.
Dorothy
D
Peprah
Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA.
Heather
H
Reese
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu.
Katharine
K
Robb
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu; Radcliffe Institute for Advanced Study, Cambridge, MA, USA; National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Peter
P
Teunis
Training Research and Networking for Development (TREND Group), Accra, Ghana.
Nii
N
Wellington
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu.
Habib
H
Yakubu
Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: karobb@emory.edu.
Christine L
CL
Moe
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003090:Coliphages / Q000302:isolation & purification; D004781:Environmental Exposure; D004784:Environmental Monitoring / Q000379:methods*; D004926:Escherichia coli / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005869:Ghana; D006801:Humans; D007223:Infant; D014871:Water Microbiology; D060753:Water Quality