Novel scale development to assess the role of sanitation access and use on household fecal contamination in Accra, Ghana

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.