A localized sanitation status index as a proxy for fecal contamination in urban Maputo, Mozambique

PLoS One. 2019 Oct 25;14(10):e0224333. doi: 10.1371/journal.pone.0224333. eCollection 2019.

Abstract

Sanitary surveys are used in low- and middle-income countries to assess water, sanitation, and hygiene conditions, but have rarely been compared with direct measures of environmental fecal contamination. We conducted a cross-sectional assessment of sanitary conditions and E. coli counts in soils and on surfaces of compounds (household clusters) in low-income neighborhoods of Maputo, Mozambique. We adapted the World Bank's Urban Sanitation Status Index to implement a sanitary survey tool specifically for compounds: a Localized Sanitation Status Index (LSSI) ranging from zero (poor sanitary conditions) to one (better sanitary conditions) calculated from 20 variables that characterized local sanitary conditions. We measured the variation in the LSSI with E. coli counts in soil (nine locations/compound) and surface swabs (seven locations/compound) in 80 compounds to assess reliability. Multivariable regression indicated that a ten-percentage point increase in LSSI was associated with 0.05 (95% CI: 0.00, 0.11) log10 fewer E. coli/dry gram in courtyard soil. Overall, the LSSI may be associated with fecal contamination in compound soil; however, the differences detected may not be meaningful in terms of public health hazards.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cities / statistics & numerical data*
  • Escherichia coli / isolation & purification
  • Feces / microbiology*
  • Mozambique
  • Sanitation / statistics & numerical data*
  • Surveys and Questionnaires

Grants and funding

This study was funded by the United States Agency for International Development (www.usaid.gov) under Translating Research into Action (Cooperative Agreement No. GHS-A- 00-09-00015-00) to JB and OC and the Bill and Melinda Gates Foundation (www.gatesfoundation.org) grant OPP1137224 to OC and JB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funder provided support in the form of salaries for author ZA in her capacity as an employee of the data collection firm WE Consult (as a contractor to LSHTM), but neither the funder nor WE Consult had any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.