The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study

ABSTRACT

Epidemiological studies have identified an increased risk of diarrheal diseases associated with using shared sanitation facilities. We hypothesized that this might be related to differences in transmission routes of pathogens. We proposed a mathematical model of two fictitious pathogens, one transmitted with an environmental reservoir and one without. We assumed that individuals susceptible to one pathogen are not susceptible to the other, and therefore, decoupled the two models. We initialized the model with 99% individuals being susceptible. We sampled the parameter space using Latin Hypercube Sampling. We simulated 10,000 parameter sets. We varied the effective shared sanitation coverage (the product of latrine coverage and users’ compliance). Our results show that, in our hypothetical scenario, across all levels of effective coverage of shared sanitation, the median final cumulative incidence of diarrheal disease was higher than that of zero coverage. Our simulation findings suggest that increasing effective coverage of shared sanitation may have limited benefits against diarrhea-causing pathogens with an environmental reservoir and may lack benefit against diarrhea-causing pathogens without an environmental reservoir given increased human contacts if latrines are poorly maintained.

KEYWORDS:

• Diarrhea
• Mathematical model
• Sanitation

Acknowledgement

MRJ and ICHF thank Drs. Swati Debroy, Ketra Rice, Melissa Hallow, and Joshua Weitz for their helpful comments as we presented to them this study at its various stages of development during their visits to Georgia Southern University. ICHF received salary support from the Centers for Disease Control and Prevention (15IPA1509134) but this paper is not related to his CDC-supported projects. The CDC has no role in the design, implementation, writing and submission of this study.