Lack of access to improved sanitation is known to impact human health via fecal contamination of hands and household drinking water. We examined whether lack of access to improved sanitation is associated with poor home hygiene, as measured by contamination of common household objects, such as a child’s toy or a cleaning item used to clean the kitchen.
In rural Bangladesh, we observed sanitation facilities and collected demographic data in households with children <2 years old. The improved sanitation group had access to improved toilet facilities, such as a pour flush latrine. The unimproved sanitation group defecated in fields or open pit latrines. The sentinel toy, a plastic ball, was provided to each household and was collected four days later and washed in a 200 ml sterile bag containing ringer’s solution. Respondents were asked to provide the material used to clean their kitchens. A 4 × 4 inch square of the material was placed in 200 ml of ringer’s solution. For each household object, quantitative counts of fecal coliforms and Escherichia coli were performed on membrane fecal coliform (mFC) and mTEC media and ten-fold dilutions were performed as required. We used the Wilcoxon Rank Sums test to assess for statistically significant differences in contamination of sentinel objects between the groups with and without access to improved sanitation.
We had information about the sentinel toy for 49 households and about the kitchen cleaning item for 59 households. For the sentinel toy, the geometric means for fecal coliforms were 8 CFU/100 ml for the improved sanitation group and 57 CFU/100 ml for the unimproved sanitation group (P = .06). The geometric means for E. coli were 2 CFU/100 ml for the improved sanitation group and 7 CFU/100 ml for the unimproved sanitation group (P = .10). The geometric means for fecal coliforms for the kitchen cleaning item were 23,936 CFU/100 ml for the improved sanitation group and 36,527 CFU/100 ml for the unimproved sanitation group (P = .56). The geometric means for E. coli were 16 CFU/100 ml for the improved sanitation group and 67 CFU/100 ml for the unimproved sanitation group (P = .14). Contamination of the toy was directly correlated with the age of the child <2 years old (fecal coliforms R = 0.53, P < 0.0001, E. coli R = 0.44, P = 0.002).
Access to sanitation in this study population was not significantly associated with the degree of contamination of household objects. A small sample size may have hampered our ability to detect an association since the sentinel toy and kitchen cleaning item had higher mean fecal bacteria levels in the unimproved group than in the improved group. Future study in a larger sample may further elucidate the utility of sentinel toy contamination as a marker of home hygiene. Kitchen cleaning items may remain moist for prolonged periods, thereby promoting local proliferation of fecal coliforms. Variability in local growth may obscure the contribution of lack of sanitation to kitchen cleaning item contamination and, thus, such cleaning items may not be useful markers of home hygiene related to sanitation.