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Research Updates

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Using Sewage Surveillance as an Early Warning Tool to Monitor the Circulation of SARS-CoV-2 in the Population
SARS-CoV-2 is primarily transmitted via the respiratory tract. However, there is recent evidence that SARS-CoV-2 is also shed in human feces and can be detected in fecal samples and wastewater. The purpose of this study is to collect and test weekly samples of wastewater immediately downstream of Emory University Hospital and wastewater influent from municipal wastewater treatment plants in metro Atlanta, in collaboration with colleagues at Georgia Institute of Technology, and compare trends in SARS-CoV-2 titer over time with number of reported COVID-19 cases in the wastewater catchment areas served by the treatment plants. The results from this study will provide valuable public health information on COVID-19 trends in metro Atlanta and may serve as an early warning system if COVID-19 infections rise as more public venues are opened or if COVID-19 infections re-emerge later in 2020/2021.  This study will enable us to adapt our wastewater analyses methods to detect SARS-CoV-2 in wastewater to determine how well we can use wastewater to monitor COVID-19 prevalence in hospital and community populations.

Inform Government Programs and Policies on Urban Sanitation
Dr. Christine Moe and her SaniPath team at The Emory CGSW created an Advisory Committee to get feedback on the use of results of the SaniPath tool on public health risks as a result of poor sanitation and fecal sludge management to more effectively influence government and development partner’s urban sanitation investments, policies, and programs to improve safe sanitation for the urban poor. The two-day meeting consisted of a global group of sanitation experts who met this past November 2015 on the Emory campus in Atlanta, Georgia. A summary of the recommendations from the Advisory Committee can be seen here: With support from the BMGF, the SaniPath team will be deploying the SaniPath tool during 2016 in Bangladesh, Senegal, Nepal and India. All of the deployments will be in partnership with the local governments in these countries and with development partners such as World Bank, WHO, EAWAG and Water and Sanitation for the Urban Poor.

Development of a Quantitative Personal Hygiene Assessment Tool (qPHAT)                   Personal hygiene practices are believed to represent intermediate behavioral factors along the causal pathways that lead to diseases. Consequently, many public health programs promote the adoption of improved personal hygiene practices for disease prevention and control. In low and middle-income settings, interventions promoting personal hygiene are often undertaken within community-based water, sanitation, and hygiene (WASH) and neglected tropical disease (NTD) programming. Valid, reliable measurement of personal hygiene practices would be useful for monitoring, evaluation, and development of better interventions. However, within the trachoma community, there exists no universally endorsed operational definition of facial cleanliness (or, conversely poor facial hygiene, poor facial “cleanliness”, or “unclean” face) or recommendations for the standardized measurement of F in SAFE programming (e.g., facial and hand hygiene, specific indicators of established F-related risk factors and related measurement metrics).

Using color theory principles, Dr. Matt Freeman and his team of researchers developed and tested a novel metric that generates quantitative measures of facial and hand cleanliness, proxy indicators of personal hygiene practices. The quantitative personal hygiene assessment tool (qPHAT) uses an 11-point color scale to rate the color of a wipe taken from the skin along the face and hand of individuals, which indicates facial and hand cleanliness. We tested this new measurement method in the Amhara region of Ethiopia during our Andilaye Trial, and found that the new way of measuring facial and hand cleanliness is reliable, meaning different people rated the wipes similarly.

*Latest Publications

May 2021
Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda
Mugambe RK, Yakubu H, Wafula ST, Ssekamatte T, Kasasa S, Isunju JB, Halage AA, Osuret J, Bwire C, Ssempebwe JC, Wang Y, McGriff JA, Moe CL

Mixed methods process evaluation of the Sundara Grama intervention promoting latrine use and safe disposal in rural Odisha, India
Sclar GD, Routray P, Majorin F, Udaipuria S, Portela G, III WJK, Nagel CL, Sola S, Caruso BA

Pathogen flows from sanitation systems in Dhaka: A quantitative environmental assessment
Amin N, Liu P, Foster T, Rahman M, Miah MR , Ahmed GB, Kabir M, Raj S, Moe CL, Willetts J

March 2021
Meteorological factors and childhood diarrhea in Peru, 2005–2015: a time series analysis of historic associations, with implications for climate change

Delahoy MJ, Cárcamo C, Huerta A, Lavado W, Escajadillo Y, Ordoñez L, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K

Effects of a combined water and sanitation intervention on biomarkers of child environmental enteric dysfunction and associations with height-for-age z-score: A matched cohort study in rural Odisha, India
Sinharoy SS, Reese H, Prajaraj I, Chang HH, Clasen T

February 2021
Water, sanitation, and hygiene practices and challenges during the COVID-19 pandemic: a 2 cross-sectional study in rural Odisha, India
Bauza V, Sclar GD, Bisoy A, Majorin F, Ghugey A, Clasen T

Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making
Foster T, Falletta J, Amin N, Rahman M, Liu P, Raj S, Mills F, Petterson S, Norman G, Moe CL, Willetts, J

The state of adolescent menstrual health in low- and middle-income countries and suggestions for future action and research
Plesons M, Patkar A, Babb J, Balapitya A, Carson F, Caruso B et al

Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries
Stoler J, Miller JD, Brewis A, Freeman MC, Harris LM, Jepson W, et al

WASH Upgrades for Health in Amhara (WUHA): study protocol for a cluster-randomised trial in Ethiopia
Wittberg DM, Aragie S, Wondyifraw T, Melo JS, Chanyalew M, Emerson P, Freeman MC, Nash S, Callahan EK, et al

January 2021
Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster, randomized controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji
Leder K, Openshaw JJ, Allotey P, Ansariadi A, Barker SF, Burge K, Clasen T, et al.

Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster-randomized trial
Mugambe RK, Mselle JS, Ssekamatte T, Ntanda M, Isunju JB, Walfula ST, Kansiime WK, Isubikalu P, Ssemwanga D, Yakubu H and Moe CL

December 2020
A framework for identifying and learning from countries that demonstrated exemplary performance in improving health outcomes and systems

Carter A, Ho K, Rothschild O, Bose N, Binagwaho A Muther K, Freeman MC et al

November 2020
The Role of the Gut Microbiome in Resisting Norovirus as Revealed by a Human Challenge Study
Patin NV, Peña-Gonzalez A, Hatt JK, Moe CL, Kirby A, Konstantinidis T

Impact of a demand-side integrated WASH and nutrition community-based care group intervention on behavioural change: a randomized controlled trial in western-Kenya
Freeman MC, Ellis A, Ogutu EA, Caruso B, Linabarger M, Micek K,
Muga R, Webb-Girard A, Wodnik B, Arriola KJ

October 2020

Less severe clinical symptoms of Norwalk virus 8fllb inoculum compared to its precursor 8flla from human challenge studies
Liu P, Rahman M, Leon J, Moe CL

The use of behavioural-science informed interventions to promote latrine use in rural India: a synthesis of findings
Lane C, Khatua S, Caruso B

September 2020
Pathogen flows from on-site sanitation systems in low-income, urban neighborhooda, Dhaka: a quantitative environmental assessmentl
Amin N, Liu P, Foster T, Rahman M, Miah MR, Ahmed GB, Kabir M, Raj S, Moe CL and Willets JDoza S, Rahman M, Unicomb L, Ahmed KM, Anand S, Selim S, Shamsudduha M, Narayan KMV, Chang H, Clasen T, Gribble M, Luby S

August 2020
Feecal contamination of the environment and child health: a systemic review and individual participant data meta-analysis
Goddard F, Pickering A, Ercumen A, Brown J, Chang H, Clasen T

July 2020
Consequences of access to water from managed aquifer recharge systems for blood-pressure and proteinuria in Southwest Coastal Bangladesh: a step-wedge, randomized cluster trial
Naser AM, Doza S, Rahman M, Unicomb L, Ahmed KM, Anand S, Selim S, Shamsudduha M, Narayan KMV, Chang H, Clasen T, Gribble M, Luby S

June 2020
The Sanipath Exposure Assessment Tool: A quantitative approach to assessing exposure to fecal contamination through multiple pathways in low-resource, urban settlements
Raj S, Wang Y, Yakubu H, Robb K, Siesel C, Green J, Kirby AE, Mairinger W, Michiel J, Null C, Perez E, Roguski K, Moe CL

May 2020
Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: a cluster-randomized controlled trial in Western Province, Rwanda
Clasen, T, Nagel C, Thomas E, Zambrano L, Musafiri S, Ngirabega J, Chislaine R, Kirby M

Shared Sanitation and the Spread of COVID-19: risks and next steps
Freeman M, Caruso, B



*Names in bold indicate CGSW Core Faculty and Fellows





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