Impacts of an urban sanitation intervention on fecal indicators and the prevalence of human fecal contamination in Mozambique

<jats:title>ABSTRACT</jats:title><jats:p>Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two non-specific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced <jats:italic>E. coli</jats:italic> gene concentrations in soil but did not impact culturable <jats:italic>E. coli</jats:italic> or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide implementation of effective interventions to safeguard health.</jats:p><jats:sec><jats:title>SYNOPSIS</jats:title><jats:p>An urban sanitation intervention had minimal and highly uncertain effects on human fecal contamination after accounting for fecal indicator sensitivity and specificity.</jats:p></jats:sec><jats:sec><jats:title>TOC GRAPHIC/ABSTRACT ART</jats:title><jats:fig id="ufig1" position="float" fig-type="figure" orientation="portrait"><jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="432000v2_ufig1" position="float" orientation="portrait" /></jats:fig></jats:sec>