{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:30:53Z","timestamp":1789536653416,"version":"build-2803163510"},"reference-count":62,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,6,7]]},"abstract":"<jats:p>Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. The two neighborhoods differed significantly in toilet coverage (78% versus 33%) and spatial clustering. Overall, 49% of toilets discharged directly into open drains (\u201cpoor FSM\u201d). Children in households with poor FSM had 3.78 times higher prevalence of enteric infection when compared with children in other households, even those without toilets. In the neighborhood with high coverage of household toilets, children in households with poor FSM had 10 times higher prevalence of enteric infection than other children in the neighborhood and drains in poor FSM clusters who had significantly higher concentrations of genogroup II norovirus. Conversely, children in households with a toilet that contained excreta in a tank onsite had 55% lower prevalence of enteric infection compared with the rest of the study area. Notably, households with a toilet in the neighborhood with low toilet coverage had more fecal contamination on floors where children played compared with those without a toilet. Overall, both toilet coverage levels and FSM were associated with environmental fecal contamination and, subsequently, enteric infection prevalence in this urban setting.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0170","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T16:07:07Z","timestamp":1490026027000},"page":"1404-1414","source":"Crossref","is-referenced-by-count":34,"title":["The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children"],"prefix":"10.4269","volume":"96","author":[{"given":"David","family":"Berendes","sequence":"first","affiliation":[{"name":"Department of Environmental Engineering, School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia."},{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kirby","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Clennon","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."},{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraja","family":"Raj","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib","family":"Yakubu","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Leon","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Robb","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Kartikeyan","sequence":"additional","affiliation":[{"name":"Wellcome Research Laboratory, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Hemavathy","sequence":"additional","affiliation":[{"name":"Wellcome Research Laboratory, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annai","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Wellcome Research Laboratory, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Ghale","sequence":"additional","affiliation":[{"name":"Wellcome Research Laboratory, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Senthil","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Community Health, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Raghava","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Community Health, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gagandeep","family":"Kang","sequence":"additional","affiliation":[{"name":"Wellcome Research Laboratory, Christian Medical College, Vellore, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Moe","sequence":"additional","affiliation":[{"name":"Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Atlanta, Georgia."},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Environ Health Perspect","first-page":"537","article-title":"Estimating the burden of disease from water, sanitation and hygiene at a global level","volume":"110","author":"Pr\u00fcss","year":"2002"},{"issue":"(Suppl 1)","key":"ref2","series-title":"Matern Child Nutr","first-page":"106","article-title":"Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries","volume":"12","author":"Mbuya","year":"2016"},{"key":"ref3","series-title":"Progress on Drinking Water and Sanitation: 2012 Update","author":"UNICEF and World Health Organization","year":"2012"},{"key":"ref4","series-title":"Lancet Infect Dis","first-page":"131","article-title":"Urbanisation and infectious diseases in a globalised 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