Multiple pathogen contamination of water, hands, and fomites in rural Nepal and the effect of WaSH interventions

Water, Sanitation, and Hygiene (WaSH) interventions are the most effective in reducing diarrheal disease severity and prevalence. However, very few studies have investigated the effectiveness of WaSH intervention in reducing pathogen presence and concentration. In this study, we employed a microfluidic PCR approach to quantify twenty bacterial pathogens in water (n = 360), hands (n = 180), and fomite (n = 540) samples collected in rural households of Nepal to assess the pathogen exposures and the effect of WaSH intervention on contamination and exposure rates. The pathogen load and the exposure pathways for each pathogen in intervention and control villages were compared to understand the effects of WaSH intervention. Pathogens were detected in higher frequency and concentration from fomites samples, toilet handle (21.42%; 5.4,0 95%CI: mean log₁₀ of 4.69, 5.96), utensils (23.5%; 5.47, 95%CI: mean log₁₀ of 4.77, 6.77), and water vessels (22.42%; 5.53, 95%CI: mean log₁₀ of 4.79, 6.60) as compared to cleaning water (14.36%; 5.05, 95%CI: mean log₁₀ of 4.36, 5.89), drinking water (14.26%; 4.37, 85%CI: mean log₁₀ of 4.37, 5.87), and hand rinse samples (16.92%; 5.49, 95%CI: mean log₁₀ of 4.77, 6.39). There was no clear evidence that WaSH intervention reduced overall pathogen contamination in any tested pathway. However, we observed a significant reduction (p < 0.05) in the prevalence, but not concentration, of some target pathogens, including Enterococcus spp. in the intervention village compared to the control village for water and hands rinse samples. Conversely, no significant reduction in target pathogen concentration was observed for water and hand rinse samples. In swab samples, there was a reduction mostly in pathogen concentration rather than pathogen prevalence, highlighting that a reduction in pathogen prevalence was not always accompanied by a reduction in pathogen concentration. This study provides an understanding of WaSH intervention on microbe concentrations. Such data could help with better planning of intervention activities in the future.