Frequently Asked Questions (FAQs)

OVERVIEW

Who can I contact with questions about how to conduct a deployment?

For general questions, please use the contact form or contact the Emory SaniPath team: help@sanipath.org.

For groups or individuals on the African continent, please contact TREND (certified training hub): info@trendgh.com

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Are there step-by-step instructions on how to create a SaniPath Tool account?

Yes! The SaniPath Wiki is a great resource for detailed information on protocols. We also have YouTube tutorials that take you through all the key steps, from creating an account, using KoBoToolbox and KoBoCollect, to analyzing the final results.

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How long does it take to perform a SaniPath deployment?

The time period for the SaniPath deployment depends on the number of neighborhoods in the deployment and the human resources that are available. A deployment with five neighborhoods typically takes 4 - 6 weeks for data collection.

 

Can the SaniPath Exposure Assessment Tool be applied to rural settings?

The methods of data collection and assumptions used in the analysis were developed through formative research that took place in urban areas. Therefore, the SaniPath Tool is validated and optimized for research that is taking place in urban or peri-urban settings. People interact with their environment very differently in rural versus urban areas and public spaces may look very different, so additional formative research would be needed to adjust the SaniPath Tool for rural areas. This is something our research group has been interested in and is considering, but as of now we do not have a validated or standardized approach for rural areas.

 

Is SaniPath open source and free to use?

Yes, the SaniPath Tool and the protocols are open source and freely accessible for all who are interested in using it, and it is not necessary to ask for permission or a license to use it. The SaniPath Tool was developed to be customizable and adaptable to different urban settings. It is important to note, however, that major changes to the code will have implications for the interpretation of the results.

 

Are there any expected costs associated with a SaniPath deployment?

The cost of implementing a deployment depends on the context where the deployment will take place. The SaniPath team has developed documents to help guide your organization to estimate the costs of a SaniPath deployment in your context. Factors to consider include estimated cost for personnel, planning and logistics, deployment activities, and laboratory activities and equipment.

 

Is it possible to conduct a SaniPath deployment without conducting the sample collection and laboratory analysis?

The full potential of the SaniPath Tool requires the collection and analysis of behavioral data through surveys and laboratory analysis of environmental samples. Without both, you will not be able to generate risk profiles or identify dominant pathways or identify dominant pathways. If sample collection and laboratory analysis are not feasible in your context, the SaniPath Tool can still serve as a means to collect meaningful behavioral data. This could be used for a situational analysis or to better understand local WASH infrastructure and WASH-related behaviors.

 

Are SaniPath representatives available for training and technical assistance?

SaniPath support is available in a variety of different packages (virtual, in-person, or mixed) depending on your needs. Please contact us to learn more using either the contact form or email us at help@sanipath.org.

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PRELIMINARY ASSESSMENT

How should we choose enumerators?

The following tips are useful when seeking enumerators for hire:

  • Enumerators should have previous survey administration or sampling experience

  • Enumerators should be familiar with the neighborhoods where the SaniPath Tool is being deployed

  • There should be equal representation of male and female enumerators

  • Hire two additional staff members than is necessary to have as back-up personnel

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How will we train enumerators?

Training enumerators is a  very important step that should be performed before the SaniPath Tool is deployed in neighborhoods. The SaniPath team recommends providing a 2-week training course with both in-class learning and hands-on training in the field. You can utilize PowerPoint presentations and reference protocols provided on the SaniPath Wiki page. For additional support from training hubs, please contact TREND (certified training hub): info@trendgh.com or the Emory SaniPath team via the contact form or email us at: help@sanipath.org

 

Why is soil not listed as a type of pathway considering that small children can actually consume soil (through hand-to-mouth transmission) while they are playing?

While children often play and sit directly on soil, we do not have a means to understand frequency or duration of contact in the way that we do for other exposure pathways. Quantifying the frequency of contact with soil would likely require structured observations to better understand behavioral interaction and ingestion, which may be complex to conduct. Therefore, soil is not listed as a pathway type at this time, but it is included in the SaniPath Wiki Sampling Protocols as a means to estimate "background" levels of contamination within a community.

 

Why is groundwater not considered as a pathway in a SaniPath Exposure Assessment?

If groundwater is a primary source of drinking water provided by the municipality, it can be considered under the pathway “Municipal Drinking Water”. Users of the SaniPath Tool have the ability to customize these pathways to fit their local context, so even if groundwater is not provided by the municipality but it is a primary source of drinking or bathing water, it can be integrated into the exposure assessment.

 

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BEHAVIORAL DATA COLLECTION

What is the difference between assent and consent?

Consent is permission given by someone at or above the legal age of consent (in the United States this is 18, but it may vary in other countries). Assent is agreement given by someone who has cannot legally give consent (i.e. they are a minor, etc.) .

 

Can we edit all the questions in the questionnaire, or just a few of them?​

Edits to questions should only be made when extra contextual information would help respondents complete the survey​. Examples of common edits to questions include adding produce types, street food examples, or clarifying behaviors that might bring someone into contact with surface water, etc.​ Your team may also choose to add answer options​, such as adding names of street food dishes and produce types that are popular in the neighborhoods where the SaniPath Tool will be deployed. You can watch this YouTube video for advanced users about how to edit surveys in Kobo for reference.

 

The following items should NOT be changed on forms: variable names, constraints, choice lists, and quantitative interval choices (in behavioral surveys). Changes to these items would result in incorrect analysis or a failure during the analysis process.

 

Can handwashing be included in the behavioral surveys to understand how pathogen spread can be reduced?​

Handwashing is a great behavioral practice to reduce exposure to fecal contamination and pathogens, and questions could be included in surveys to ask about handwashing behaviors, but this would not be reflected in the final analysis. No standard way to account for different levels of contamination reduction on hands to prevent hand-to-mouth ingestion exists at the moment.

 

If there is a more heterogeneous group in our study, how is Behavioral Data collection validated?

If there are heterogeneous populations in a community, you can validate behavioral data collection by ensuring all groups are represented in the sampling frame​. This can be achieved by:​

  • Representative spatial distribution of survey data collection to ensure that all sub-populations are reached​

  • Ensuring sufficient numbers of each type of survey are collected for different sub-populations

 

How should I make the survey data representative for the selected neighborhood? What percent of the total population of the selected city should be surveyed? ​

Demarcation of neighborhoods is based on either the local administrative demarcations or informal community designated boundaries​. If a digital map is available, you can divide the neighborhood into equidistant grids and uniformly collect data throughout a neighborhood. Otherwise, a transect walk with a community leader or liaison can be performed to identify areas where surveys should be performed to achieve representative data collection​. The SaniPath team recommends a minimum of 100 household surveys. If the resources are available, four community surveys and four school surveys can be added to the 100 household surveys. The SaniPath Tool is able to make meaningful projections of the exposure behavior of a community with these minimum data.

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For the school survey, if you have only mixed schools in a neighborhood, do you separate the girls and the boys?​

Yes, we recommend separating surveys for boys and girls. This will inform gender-based programming decisions if there are differences in exposure to fecal contamination. ​ However, if it is not possible to separate boys and girls, you can still conduct the surveys and note the responses based on gender for each question. This may require an additional team member(s) to facilitate.

 

SAMPLE COLLECTION

Is ten samples per pathway sufficient?

The SaniPath team recommends collecting a minimum of ten samples per pathway in each neighborhood, regardless of the population size. Based on our validation process, this sample size should be sufficient for most contexts. For larger geographic areas, we recommend collecting more samples, if possible.

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Are there any guidelines on how large the neighborhood boundary should be for sample collection? Should we consider the whole community or divide it?

The selected boundary is based on the community of interest. For sampling purposes, divide the community into gridded segments, and collect samples randomly within each segment.

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Can we use any other sterilized bottles instead of Whirl-Pak bags?

Yes, other sterilized bottles can be used in place of Whirl-Pak bags, but it is important that they have undergone necessary auto-claving and sterilizing procedures before use. ​Always collect a negative control sample in the field to ensure the bottles and Whirl-Pak bags are aseptic.

 

I am having trouble procuring the EnviroMax swabs for sampling of latrines. Is there a recommended substitute?

Unfortunately, at this time, we have not validated an alternative method for collecting samples from latrines, and the protocol does require the use of EnviroMax swabs.  If the swabs are not attainable, your team may consider removing latrines as a pathway in the deployment. If you choose to use an alternative swab that has not been validated, results may not be as accurate.

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Are samples collected during the household surveys?

No, samples are not collected during household surveys. SaniPath deployments focus on the public domain to assess exposure to fecal contamination. Therefore, no samples are collected from within private households.

 

LAB PROCESSING AND ANALYSIS

Is it possible to store samples for more than seven hours until I can transport them to be tested in another neighboring city with my preferred laboratory?

No, it is not recommended to store samples for more than seven hours before they are delivered to the laboratory as doing so may compromise the results. The SaniPath team recommends storing samples on ice during field sample collection and delivering them to a laboratory within seven hours of collection​ to minimize die off of E. coli.

 

How do I identify appropriate laboratory facilities?

It is important to ensure your team has access to the necessary lab capacity to carry out a full SaniPath deployment.  Getting recommendations from key informants and partners ​is a great place to start.  Important points to consider when selecting a laboratory facility include:

  • Experience with Membrane Filtration or IDEXX methods​

  • Necessary equipment is​ available

  • Qualified staff​

  • Laboratories that specialize in water testing​

  • Distance from sample collection sites 

 

Which method (Membrane Filtration or IDEXX) do you recommend for analyzing fecal contamination?

Both Membrane Filtration (MF) and IDEXX produce accurate results when protocols are properly followed and sterilization techniques are used. When deciding which method to use, consider the equipment and supplies already in the laboratory​. For more information about MF and IDEXX protocols, check out the SaniPath Wiki.

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Can alternative media be used when plating for the Membrane Filtration protocol?

We have validated that several media types work well with the MF protocol.  These include BBL MI agar, mColiBlue, BioRad Rapid E. coli 2 media, or Chromocult.  Always refer to the manufacturer’s instructions for proper use and correct identification of E. coli colonies.

 

How do I interpret the readings from Membrane Filtration?

It is important to remember to incubate petri dishes for 24 hours.  The next step is to count the number of colonies of E.coli and Total Coliforms that have grown on the filter. For more information about how to interpret MF results, check out SaniPath Wiki. 

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Has the possibility of using qPCR been explored? ​

Yes, qPCR has been used alongside SaniPath methods in more complex studies that test for pathogens in addition to E. coli. Check out the Related Research page to learn more about the AcChoPaCE and SaniPath Typhoid studies.

 

MOBILE DATA COLLECTION

How secure is sensitive information?

SaniPath data is stored on a secured server in the United States. It is a password-protected server that is only accessible by SaniPath personnel.

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Does the mobile data application require internet or cellular service to fill out?

No, internet or cellular connection is not necessary to fill out forms in the KoBoToolbox application. These are only needed to initially download the application and the necessary forms. Once the application and forms are downloaded onto the mobile device, you can use it without internet or cellular connection. The data will be stored on your device and uploaded to the server once you return to an area with sufficient service or internet.

 

How do you integrate local language in the mobile data collection process?

The mobile data collection platform can support different languages and scripts, and you can include a translation of questions in the local language in the application. Language settings can be set during the configuration stage in the SaniPath Tool portal or by customizing the ODK forms. For reference, check out the Advanced Users: KoBo Survey Editing YouTube video.

 

Why do I need a different email address for every deployment in the SaniPath Tool portal? Why is it not possible to create new folder for each new deployment within the same account created?

Yes, you do need a different email address for every deployment ​(i.e. every city), but you do not need a different email address for every neighborhood in one deployment. Currently, the SaniPath Tool platform does not support multiple deployments within one account and the SaniPath team recommends creating a new Gmail address for each deployment. 

 

INTERPRETING RESULTS

Are the final results auto-generated or do we need to use other software to generate the results?​

Data from a SaniPath Exposure Assessment Tool are automatically analyzed and results are automatically generated! You can find them on the analysis tab of your account at tool.sanipath.org​. The auto-generated results include:​ pie charts of behavioral results​, histograms of environmental contamination​, risk profiles, and a final report that synthesizes findings.

 

I have created an account and entered two surveys, but I am not able to run and visualize the analysis. Are there certain requirements that need to be met before I can see analysis results? ​

It is important to keep in mind that results may not be representative of your deployment area if the recommended minimum number of surveys and environmental samples are not met. However, if you have met the minimum criteria and are not able to see the results, it may be due to the format of your Sample or HH ID variables. To correct this, you should only use alphanumeric IDs for these variables. If you are still experiencing difficulties, email us at help@sanipath.org. We will help troubleshoot your issue.

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​Are the results from past deployments of the SaniPath Tool available?

Yes! You can check out the Results Dashboard to view results from previous deployments on our website.  De-identified data from past deployments is also available for download under the Results tab.

 

ENGAGING STAKEHOLDERS

Is stakeholder engagement an important part of the SaniPath process? How do I engage stakeholders?

Yes! Engaging stakeholders is a critical piece of this work. If you engage stakeholders early on in the process, you can ensure that you work aligns with their interests before data collection commences. Here are some practical steps to follow to engage stakeholders:

  • Identify key stakeholders

  • Define their potential roles in a deployment of the SaniPath Exposure Assessment Tool

  • Determine if there are any helpful resources they can contribute

  • Identify dynamics amongst the stakeholders​

  • Facilitate creation of the optimum stakeholder group

  • Create an engagement plan​

  • Track stakeholder engagement throughout the project

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Stakeholder engagement helps turn results from a SaniPath Exposure Assessment into evidence-driven action. Check out our blog post to read about an example of how SaniPath and TREND engaged with stakeholders in Ghana.