Alongside efforts to improve safe management of feces along the entire sanitation chain, including after the toilet, global sanitation efforts are focusing on universal access ‘basic’ services: onsite facilities that safely contain excreta away from human contact. Although fecal sludge management is improving in urban areas, open drains remain a common fate for feces in these often densely-populated neighborhoods in low-income countries. To-date, it is unclear to what extent complete coverage of onsite sanitation reduces fecal contamination in the urban environment and how fecal contamination varies within urban drains across neighborhoods by sanitation status within a city. We assessed how neighborhood levels of environmental fecal contamination (via spatially-representative sampling of open drains for E. coli) varied across four neighborhoods with varying income, type and coverage of household sanitation facilities, and population density in Accra, Ghana. Neighborhoods with very high sanitation coverage (≥89%) still had high (>4 log₁₀ CFU/100 mL) E. coli concentrations in drains. Between-neighborhood variation in E. coli levels among the high coverage neighborhoods was significant: drain concentrations in neighborhoods with 93% and 89% coverage (4.7 (95% CI: 4.5, 4.9) & 4.9 (95% CI: 4.5, 5.3) log₁₀ CFU/100 mL, respectively) were higher than in the neighborhood with 97% coverage (4.1 log₁₀ CFU/100 mL, 95% CI: 3.8, 4.4 log₁₀ CFU/100 mL). Compared with the highest coverage neighborhood, the neighborhood with lowest coverage (48%) also had higher E. coli concentrations (5.6 log₁₀ CFU/100 mL, 95% CI: 5.3, 5.9 log₁₀ CFU/100 mL). Although fecal contamination in open drains appeared lower in neighborhoods with higher onsite sanitation coverage (and vice versa), other factors (e.g. fecal sludge management, animals, population density) may affect drain concentrations. These results underscore that neighborhood-level onsite sanitation improvements alone may not sufficiently reduce fecal hazards to public health from open drains. These findings supporting the need for integrated, city-level fecal sludge management alongside multifaceted interventions to reduce fecal contamination levels and human exposure.

除了努力改善整个卫生链（包括洗手间）后粪便的安全管理外，全球卫生工作还着重于普遍使用的“基本”服务：现场设施，其安全地隔离了人类无法接触的排泄物。尽管城市地区的粪便污泥管理有所改善，但在低收入国家这些人口稠密的社区中，排泄口仍然是粪便的共同命运。迄今为止，尚不清楚现场卫生设施的全面覆盖能在多大程度上减少城市环境中的粪便污染，以及根据城市内的卫生状况，跨社区的城市排水沟中粪便污染如何变化。我们评估了环境粪便污染的邻域水平（通过具有代表性的大肠杆菌明渠排水取样））在四个社区中有所不同，加纳阿克拉的收入，家庭卫生设施的类型和覆盖范围以及人口密度各不相同。卫生覆盖率很高（≥89％）的社区的排水管中大肠杆菌浓度仍然很高（> 4 log ₁₀  CFU / 100 mL）。在间附近变化大肠杆菌高覆盖率的街区中的水平是显著：在居民区漏极浓度的93％和89％的覆盖率（4.7（95％CI：4.5，4.9）4.9（95％CI：4.5，5.3） log ₁₀  CFU / 100 mL分别高于覆盖率为97％的邻域（4.1 log ₁₀  CFU / 100 mL，95％CI：3.8，4.4 log ₁₀ CFU / 100mL）。与覆盖率最高的社区相比，覆盖率最低的社区（48％）的大肠杆菌浓度也更高（5.6 log ₁₀  CFU / 100 mL，95％CI：5.3，5.9 log ₁₀ CFU / 100mL）。尽管在具有较高现场卫生覆盖率的社区中，露天排水沟中的粪便污染似乎较低（反之亦然），但其他因素（例如粪便污泥管理，动物，人口密度）可能会影响排水沟浓度。这些结果强调，仅靠社区水平的现场卫生改善可能无法充分减少排泄物对公共卫生的粪便危害。这些发现支持对城市级粪便污泥进行综合管理以及减少粪便污染水平和人体暴露的多方面干预措施的需求。