Holcomb, D. A.; Knee, J.; Capone, D.; Sumner, T.; Adriano, Z.; Nalá, R.; Cumming, O.; Brown, J.; Stewart, J. R. Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique. Environmental Science & Technology. 2021. https://doi.org/10.1021/acs.est.1c01538.
ABSTRACT: Fecal source tracking (FST) may be useful to assess
pathways of fecal contamination in domestic environments and to
estimate the impacts of water, sanitation, and hygiene (WASH)
interventions in low-income settings. We measured two nonspecific
and two human-associated fecal indicators in water, soil, and
surfaces before and after a shared latrine intervention from low-
income households in Maputo, Mozambique, participating in the
Maputo Sanitation (MapSan) trial. Up to a quarter of households
were impacted by human fecal contamination, but trends were
unaffected by improvements to shared sanitation facilities. The
intervention reduced Escherichia coli gene concentrations in soil but
did not impact culturable E. coli or the prevalence of human FST
markers in a difference-in-differences analysis. Using a novel
Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide the implementation of effective interventions to safeguard health.