Effect of Neighborhood Sanitation Coverage on Fecal Contamination of the Household Environment in Rural Bangladesh.

Enteric pathogens can be transmitted within the household and the surrounding neighborhood. The objective of this study was to understand the effect of neighborhood-level sanitation coverage on contamination of the household environment with levels of fecal indicator bacteria in rural Bangladesh. We conducted spot-check observations of sanitation facilities in neighboring households (NHs) within a 20-m radius of target households with children aged 6-24 months. Sanitation facilities were defined as improved (a private pit latrine with a slab or better) or unimproved. Fecal coliforms (FCs) on children's hands and sentinel toy balls were measured and used as indicators of household-level fecal contamination. We visited 1,784 NHs surrounding 428 target households. On average, sentinel toy balls had 2.11(standard deviation [SD] = 1.37) log10 colony-forming units (CFUs) of FCs/toy ball and children's hands had 2.23 (SD = 1.15) log10 CFU of FCs/two hands. Access to 100% private improved sanitation coverage in the neighborhood was associated with a small and statistically insignificant difference in contamination of sentinel toy balls (difference in means = -0.13 log10 CFU/toy ball; 95% confidence intervals [CI]: -0.64, 0.39; P = 0.63) and children's hands (difference in means = -0.11 log10 CFU/two hands; 95% CI: -0.53, 0.32; P = 0.62). Improved sanitation coverage in the neighborhood had limited measurable effect on FCs in the target household environment. Other factors such as access to improved sanitation in the household, absence of cow dung, presence of appropriate water drainage, and optimal handwashing practice may be more important in reducing FCs in the household environment

A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh.

We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6-24 months in rural Bangladesh. We defined "basic" sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: -0.31 log10 colony forming units [CFU]/toy ball; 95% confidence interval [CI]: -0.61, -0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: -0.38 log10 CFU/toy ball; 95% CI: -0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households

Safe distances between groundwater-based water wells and pit latrines at different hydrogeological conditions in the Ganges Atrai floodplains of Bangladesh.

BACKGROUND: Groundwater drawn from shallow tubewells in Bangladesh is often polluted by nearby pit latrines, which are commonly used toilets in rural and sub-urban areas of the country. METHODS: To determine the minimum safe distance of a tubewell from a pit latrine in different hydrogeological conditions of Bangladesh, 20 monitoring wells were installed at three study sites (Manda, Mohanpur and Bagmara) with the vertical and horizontal distances ranging from 18-47 to 2-15 m, respectively. Water samples were collected three times in three seasons and tested for faecal coliforms (FC) and faecal streptococci (FS) as indicators of contamination. Soil samples were analysed for texture, bulk density and hydraulic conductivity following standard procedures. Sediment samples were collected to prepare lithological logs. RESULTS: When the shallow aquifers at one of the three sites (Mohanpur) were overlained by 18-23-m-thick aquitards, the groundwater of the monitoring wells was found contaminated with a lateral and vertical distances of 2 and 31 m, respectively. However, where the aquitard was only 9 m thick, contamination was found up to lateral and vertical distances of 4.5 and 40.5 m, respectively. The soil textures of all the sites were mainly composed of loam and sandy loam. The hydraulic conductivities in the first aquifer at Manda, Mohanpur and Bagmara were 5.2-7.3, 8.2 and 1.4-15.7 m/h, respectively. CONCLUSIONS: The results showed that the safe distance from the tubewell to the pit latrine varied from site to site depending on the horizontal and vertical distances of the tubewell as well as hydrogeological conditions of a particular area

Policy reform for safe drinking water service delivery in rural Bangladesh

The Government of Bangladesh has provided global leadership in progress to improved drinking water access, with an estimated coverage of 98.5% of its 160 million citizens in 2019. However, the coverage decreases to 42.5% when service delivery accounts for indicators of water quality, proximity and sufficiency (UNICEF/MICS, 2019). This report seeks to support the Government of Bangladesh in its review and reform of the 1998 National Policy for Safe Water Supply and Sanitation, and to introduce the ‘SafePani’ model as one responseto achieving SDG 6.1 in rural areas. The design of the SafePani model is informed by collaborative work of the REACH programme with national and local partners in the coastal zone (Khulna) and central plains (Chandpur). Interdisciplinary research reveals intersecting challenges – hydroclimatic and water quality risks, public finance and private enterprise, and social and spatial inequalities – and highlights opportunities for reforms in policy and practice

Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae:An Emerging Concern to Public Health in Bangladesh

The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was bla(CTX-M-1) (91%), followed by bla(TEM) (76.1%), bla(SHV) (68.7%), bla(OXA-1) (29.9%), bla(GES) (14.9%), bla(CTX-M-9) (11.9%), and bla(CTX-M-2) (4.5%). The carbapenemase genes bla(KPC) (55.2%), bla(IMP) (28.4%), bla(VIM) (14.9%), bla(NDM-1) (13.4%), and bla(OXA-48) (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections

Safe distances between groundwater-based water wells and pit latrines at different hydrogeological conditions in the Ganges Atrai floodplains of Bangladesh

Background: Groundwater drawn from shallow tubewells in Bangladesh is often polluted by nearby pit latrines, which are commonly used toilets in rural and sub-urban areas of the country. Methods: To determine the minimum safe distance of a tubewell from a pit latrine in different hydrogeological conditions of Bangladesh, 20 monitoring wells were installed at three study sites (Manda, Mohanpur and Bagmara) with the vertical and horizontal distances ranging from 18\u201347 to 2\u201315 m, respectively. Water samples were collected three times in three seasons and tested for faecal coliforms (FC) and faecal streptococci (FS) as indicators of contamination. Soil samples were analysed for texture, bulk density and hydraulic conductivity following standard procedures. Sediment samples were collected to prepare lithological logs. Results: When the shallow aquifers at one of the three sites (Mohanpur) were overlained by 18\u201323-m-thick aquitards, the groundwater of the monitoring wells was found contaminated with a lateral and vertical distances of 2 and 31 m, respectively. However, where the aquitard was only 9 m thick, contamination was found up to lateral and vertical distances of 4.5 and 40.5 m, respectively. The soil textures of all the sites were mainly composed of loam and sandy loam. The hydraulic conductivities in the first aquifer at Manda, Mohanpur and Bagmara were 5.2\u20137.3, 8.2 and 1.4\u201315.7 m/h, respectively. Conclusions: The results showed that the safe distance from the tubewell to the pit latrine varied from site to site depending on the horizontal and vertical distances of the tubewell as well as hydrogeological conditions of a particular area

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

REACH Khulna Seasonal Water Quality Analysis (2020-21)

Water samples (n=131) were taken from 115 waterpoints in Polder 29 of Khulna district (Bangladesh) and tested at the Laboratory Environmental Health at the International Centre for Diarrhoeal Diseases (icddr,b) to understand seasonal variations in water quality across different water supply technologies. E.coli was test before and after decontamination of source outlet, along with analysis of vibrio cholerae, arsenic, iron, manganese, chloride, total dissolved solids, and turbidity across three seasons (Intermediate/winter - Jan 2020, Wet/monsoon - June 2020, Dry/summer - March 2021). The sample includes a variety of private, community and school waterpoints, including tubewells, pond sand filters, reverse osmosis plants, piped water schemes and managed aquifer recharge sites. The dataset was used in the following publications: a) Hope et al. (2021). Policy reform for safe drinking water service delivery in rural Bangladesh. REACH Working Paper 9. University of Oxford, UK. http://dx.doi.org/10.5287/ora-e9x2onovo. b) Shamsudduha M. & Hoque, S. (2024). Water risks and rural development in Coastal Bangladesh at this link: https://oxfordre.com/environmentalscience/display/10.1093/acrefore/9780199389414.001.0001/acrefore-9780199389414-e-831