News Release: International, Research

Feb. 17,  2011

Center for Global Safe Water Launches Study to Assess Risks of Fecal Contamination in Low-Income Urban Environments

Bill & Melinda Gates Foundation awards $2.5M grant to Rollins School of Public Health; study begins in Accra, Ghana

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The Center for Global Safe Water in the Rollins School of Public Health, Emory University, has received a $2.5 million grant from the Bill & Melinda Gates Foundation to study ways in which individuals are exposed to human waste in cities of the developing world.

For decades, cities in the developing world have continued to grow rapidly without improving water and waste disposal infrastructure. According to World Health Organization (WHO) estimates, 2.6 billion individuals worldwide do not have access to toilets or sanitation facilities, and approximately 884 million people do not have access to clean drinking water. Globally, children remain the primary victims of illnesses related to poor water and sanitation.

It is difficult to estimate the health risks associated with a lack of water and sanitation in an urban setting due to the lack of data. Because people can be exposed to fecal contamination through food, drinking water and other environmental routes, it can be difficult to determine the most effective interventions to prevent disease transmission.

Rollins professors Christine Moe, PhD, and Clair Null, PhD, in the Hubert Department of Global Health; Peter Teunis, PhD, visiting professor in the Hubert Department of Global Health and the National Institute for Public Health and the Environment (RIVM) in the Netherlands; and Bernard Keraita, PhD, of the International Water Management Institute, will lead the study, Assessment of Fecal Exposure Pathways in Low-Income Urban Settings.

The Center for Global Safe Water project will develop methods to assess the risk that these contaminants pose to human health and provide critical information to help design effective interventions to prevent transmission of enteric diseases.

The study will begin with an analysis of sanitation practices and facilities in Accra, Ghana, and how residents in low-income neighborhoods are exposed to fecal contamination in their environment. Researchers will observe behaviors that are associated with exposure and take samples from the environment to test for fecal contamination in fresh produce, hands, soil, drinking water, recreational water and drainage ditches.  Based on the detailed results from Accra, the research team will develop tools to characterize exposure and risk.

Accra is representative of many rapidly growing cities in sub-Saharan Africa. In Accra, like many coastal African cities, there are no operational public sewage and fecal sludge treatment plants. Trucks and marine outfalls dump most of the untreated excreta into the coastal ocean. The information from this study about the most common ways in which residents in Accra are exposed to fecal pathogens and the health risks associated with these exposure routes should be applicable to many other cities in developing countries.

“With the increasing trend toward urbanization all over the world, it is crucial that we understand the sources and movement of fecal contamination in cities and the primary pathways through which vulnerable populations, like children in low-income neighborhoods, become exposed to these hazards,” says Moe. “We hope that the application of the tools we develop to study cities in developing countries will inform sanitation investment priorities and contribute to WHO-recommended approaches for assessing health risks from fecal exposures.”

The study will help promote strategic investments in sanitation and facilitate evidence-based decisions on sanitation interventions, a critical step in reducing the disease burden and improving child health in developing countries.


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focusing on teaching, research, health care and public service.

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