Assessing Public Health Risks from Unsafe Fecal Sludge Management

The SaniPath Tool is designed to assess risk related to poor sanitation and to help prioritize sanitation investments based on the exposures that have the greatest public health impact.

Rapid urbanization has led to a sanitation crisis in urban and peri-urban areas. How can limited public funding be effectively utilized to improve sanitation and reduce public health risks?

noun_poop thinking_3249297.png

What pathways of exposure to fecal contamination pose the greatest health risk?

What types of sanitation investments can have the biggest impact on reducing public health risk?

What is the risk of exposure to fecal contamination in the urban environment?

What additional information is needed after creating a "Shit Flows Diagram"?


The SaniPath Exposure Assessment Tool (“the Tool”), was developed by the Center for Global Safe WASH at Emory University to identify and compare risk of exposure to fecal contamination across multiple exposure pathways associated with inadequate sanitation and fecal sludge management. This approach follows the framework for quantitative microbial risk assessment, with an emphasis on hazard identification, exposure assessment, risk characterization, and risk management. The Tool provides guidance for standardized primary data collection, automates the exposure assessment analysis, and visualizes the results in a way that is accessible and understandable to people with a variety of backgrounds. It enables users to develop a robust evidence base for advocacy and decision making in the WASH sector. The Tool is free and open access for all, including those who may want to use it or further improve and build upon it.

The SaniPath web-platform was developed in conjunction with EpiTech Consulting to manage and monitor data collection and visualize data. The platform is integrated with KoBo Toolbox and data are collected via downloadable mobile forms and uploaded to a SaniPath server. An analytical dashboard automatically retrieves data from the server and performs the exposure analysis on a daily basis. From the dashboard, the user can view pie charts, histograms, and People Plots and automatically generate a draft final report (Raj et al., PLOS ONE 2020).  

SaniPath Exposure Assessment Toolkit Workflow:



Users are guided through sequential modules, from planning and collecting data to analyzing results and creating reports.


Planning for using the Tool consists of estimating the resources, time, and costs required to conduct a SaniPath Exposure Assessment.

Preliminary Assessment

Key informant interviews and transect walks are performed to identify target neighborhoods for the exposure assessment and  potential routes of exposure to fecal contamination. Users will gather information on the city’s sanitation infrastructure, target communities, observations from transect walks, pathways to be considered in the final assessment, and maps of each target community.

Mobile Data Collection

Environmental and behavioral data is collected through KoBoCollect, a free and open-source application for Android devices. Once data collection is complete, the data is stored in an online repository.

Risk Profiles and Summary Statistics

Users can generate and view risk profiles on the online interface after the data is uploaded. Risk profiles are developed using Bayesian analysis that incorporates behavioral frequency and environmental sample data with other parameters such as intake volume and duration of exposure. Summary statistics, charts, and graphs are automatically generated, and the results can be sorted by population, pathway, and neighborhood.

Final Report

The final report provides an overview of the study, including details on the target neighborhoods, sample and survey data collected, and interpretation of the results. The final report also includes possible programmatic and policy recommendations based on the pathways that pose the greatest risk of exposure. 



The SaniPath Exposure Assessment Tool characterizes the exposure of adults and children to ten different environmental pathways in the public domain. SaniPath's approach involves collecting and processing environmental samples and behavioral exposure data from these pathways. The SaniPath Tool does not include pathways of exposure in the private domain or those strongly related to personal hygiene as they are less influenced by public intervention.


Surface Water

Public Latrines





Municipal Water

Open Drains

Bathing Water


Street Food

Ocean Water

Data Collection Activities:


Environmental samples are collected from each exposure pathway. Ten samples are collected from each pathway in every neighborhood where the SaniPath Tool is deployed.


Environmental samples are processed in a laboratory to determine the magnitude of fecal indicator bacteria (E. coli) in each sample. Membrane Filtration (pictured above) or IDEXX can be used for this process.

Behavioral data is collected via surveys at the community, school, and household levels. This data captures the frequency of exposure-related behaviors for both adults and children.

For more information on data collection protocols: