Document Type

Thesis

Date of Degree

Spring 2015

Degree Name

MS (Master of Science)

Degree In

Epidemiology

First Advisor

Kelly K. Baker

Second Advisor

Christine Petersen

Abstract

Diarrheal disease is one of the leading causes of mortality of children under 5 years of age. Despite this, diarrheal disease is easily preventable through adequate water, sanitation and hygiene. Sanitation access is currently classified as “improved” or “unimproved” based on level of latrine access. This does not account for differences in human behaviors, or differences in exposure risk. A sanitation score was built using behavioral and access data in order to better classify the sanitation environment of a household. Due to low levels of sanitation access and practice of open defecation in Ghana, households in four neighborhoods in Accra, Ghana were selected to participate in the data collection. Data was collected through a survey, environmental sanitary inspections and collection of hand rinse and environmental swab samples. These samples were then tested for fecal indicators, by measuring presence and concentration of E. coli and human Adenovirus. A novel sanitation score based on latrine access and use for each household was created. Hierarchical linear and logistic regression was used to compare the sanitation score to the environmental contamination as indicated by the E. coli and Adenovirus. Higher sanitation scores were significantly associated with increases in Adenovirus concentration (PR=1.6, 95%CI=1.1, 2.2). The sanitation score was not significantly associated with E. coli or presence of Adenovirus. Further development of a sanitation score variable could help to better understand sanitation environments.

Public Abstract

Diarrheal disease is one of the leading causes of mortality of children under 5 years of age, and is easily preventable through adequate water, sanitation and hygiene. Sanitation access is currently classified as “improved” or “unimproved” based on level of latrine access. This does not account for differences in human behaviors, or differences in exposure risk. A sanitation score was built using behavioral and access data in order to better classify the sanitation environment of a household. Due to low levels of sanitation access and practice of open defecation in Ghana, households in four neighborhoods in Accra, Ghana were selected to participate in the data collection. The sanitation score was based on latrine access and defecation and waste disposal for children in each household based on surveys and observations from a caretaker in the household. This score was validated against environmental samples of hand rinses and swabs collected from each household. Human Adenovirus strains and E. coli in samples were used as indicators of fecal contamination in the samples. Higher sanitation scores were significantly associated with increases in Adenovirus concentration (PR=1.6, 95%CI=1.1, 2.2). The sanitation score was not significantly associated with E. coli or presence of Adenovirus. This suggests that sanitation access and behavior are significantly associated to exposure risk for diarrheal pathogens.

Keywords

publicabstract, hygiene, Sanitation, WASH

Pages

vii, 39 pages

Bibliography

Includes bibliographical references (pages 27-28).

Copyright

Copyright 2015 Rebecca Lyn Ritter

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