Examining the effect of neighborhood sanitation coverage on childhood diarrheal disease in rural Bangladesh

Uppsala universitet, Internationell barnhälsa och nutrition Univ Michigan, Dept Epidemiol, Sch Publ Hlth, Ann Arbor, MI 48109 USA. Univ Michigan, Dept Epidemiol, Sch Publ Hlth, Ann Arbor, MI 48109 USA. Univ Michigan, Dept Epidemiol, Sch Publ Hlth, Ann Arbor, MI 48109 USA. Int Ctr Diarrhoeal Dis Res Bangladesh icddr b, Hlth Syst & Populat Studies Div, Environm Hlth & WASH, Dhaka 1212, Bangladesh. Univ Calif Berkeley, Sch Publ Hlth, Dept Environm Hlth Sci, Berkeley, CA 94720 USA. Univ Calif Berkeley, Dept Civil & Environm Engn, Berkeley, CA 94720 USA.;Chan Zuckerberg Biohub, San Francisco, CA 94158 USA. Univ Calif San Francisco, Francis I Proctor Fdn, San Francisco, CA 94158 USA. Stanford Univ, Woods Inst Environm, Stanford, CA 94305 USA. Univ Calif Berkeley, Sch Publ Hlth, Div Epidemiol & Biostat, Berkeley, CA 94720 USA. Emory Univ, Rollins Sch Publ Hlth, Gangarosa Dept Environm Hlth, Atlanta, GA USA. North Carolina State Univ, Dept Forestry & Environm Resources, Raleigh, NC USA. Univ Michigan, Dept Epidemiol, Sch Publ Hlth, Ann Arbor, MI 48109 USA. 2026

Background: Neighborhood-level sanitation coverage may offer significant indirect protection against diarrheal disease, an observation that has been supported by several studies. Methods: We analyzed the protective effect of neighborhood sanitation coverage using harmonized data from two studies: a randomized control trial (RCT) examining the effectiveness of improved compound-level sanitation and an observational study that collected information on compounds within 100 m of the RCT study compounds. We developed the Neighborhood Sanitation & Fecal Exposure (NSFE) metric, which estimates the fecal contamination at a study compound based on the demographic and sanitation characteristics of the neighborhood. NSFE is a function of the number of individuals and latrine quality at surrounding compounds, the distance to neighboring compounds, and the effectiveness of hygienic and unhygienic latrines relative to open defecation. We modeled the relationship between NSFE and childhood diarrheal prevalence within RCT study compounds. Finally, we examined counterfactual scenarios to understand how much of the observed diarrheal burden was attributable to neighbors' latrine quality. Results: We estimated a 3.6-fold increase in diarrheal prevalence between compounds with the highest and lowest NSFE, with about two-thirds of this association concentrated in compounds between the 90th and 100th percentile of NSFE values. In counterfactual scenarios, we estimate that 15.5 % of the entire diarrheal disease burden in children living in the study compounds would be eliminated if all neighboring compounds had high-quality latrines. Conclusion: Community effects associated with neighborhood sanitation coverage are important drivers of diarrheal disease and should be considered in future designs of sanitation interventions. Our findings support the importance of universal basic sanitation as a target for United Nations Sustainable Development Goal 6.

Sanitation coverage; WASH; Fecal contamination; Diarrheal disease; Public Health, Global Health and Social Medicine; Folkhälsovetenskap, global hälsa och socialmedicin; Article in journal; info:eu-repo/semantics/article; text

10.1016.j.ijheh.2025.114732

Open access content. Open access content
info:eu-repo/semantics/restrictedAccess

English

UPE oai:DiVA.org:uu-575553
0000-0003-0520-2683
doi:10.1016/j.ijheh.2025.114732
PMID 41370917
ISI:001638944400001
Scopus 2-s2.0-105024240272
1582137693

UPPSALA UNIV LIBR
From OAIster®, provided by the OCLC Cooperative.

edsoai.on1582137693