Role of Community in Swachh Bharat Mission. Their Knowledge, Attitude and Practices of Sanitary Latrine Usage in Rural Areas, Tamil Nadu

Psychological and socio-cultural factors affecting latrine ownership and usage in rural South India

The levels of latrine utilization were lower than the levels of latrine ownership in rural areas owing to certain psycho-social barriers hindering latrine construction and consistent utilization. The study was aimed to identify the proportion of latrine construction and usage and to explore the psychological, socio-cultural and structural factors influencing latrine ownership and utilization. A community-based cross-sectional study was carried out at the four villages of Villupuram district for three months. After IEC clearance, information was collected from a representative sample of 422 households. Direct observation of the latrines was employed along with surveys. The data were entered and analysed in MS Excel. Categorical variables were expressed as frequencies and percentages. Further, the reasons were categorized into psychological, socio-cultural and structural factors. About 54.7% households owned a latrine and among them 46.8% were using it. Psycho-social factors such as convenience, habitual nature, privacy and space constraints in open defecation influenced latrine ownership. Fear of snakes and insects, safety and protection, time saving and proper functioning latrines with availability of water facilitated latrine utilization are of concern. A multi-faceted strategy employing context-specific behaviour change communication along with Government's financial support would improve both latrine construction and utilization.

Synthesis of water, sanitation, and hygiene (WaSH) spatial pattern in rural India: an integrated interpretation of WaSH practices

Rural areas largely lack access to improved drinking water, sanitation, and hygiene (WaSH) facilities in India. This requires documentation of WaSH practices at the local level for better understanding and sustainable development. In this paper, a global positioning system (GPS)-based household survey was carried out in 67 villages of Phagi tehsil using individual questionnaires to evaluate the existing WaSH conditions spatially at the panchayat level. Three sub-indices were used for WaSH risk areas mapping and prediction with the integration of machine learning algorithms. Survey results indicate the improvement in the availability of toilet facilities; however, a gap was found between toilet ownership and its usage by villagers. Data show that only six panchayats have almost zero open defecation practices among the 32 panchayats of Phagi tehsil. The findings highlight that presence of toilets in house, water supply in toilets, and high literacy rate lead to an increase in toilet usage by the population. WaSH index scores indicate that panchayats like Mandawari, Mendwas, Chandma Kalan, and Rotwara have worst conditions and fall in the high-risk category. Moreover, support vector machine regression (SVMR) results reveal that WaSH scores are mainly affected by open defecation (r = 0.94), water supply in toilets (r = 0.92), and female members' participation in sanitation facilities decision-making (r = 0.53), followed by literacy rate (r = 0.33). Findings demonstrate the association between gender inequalities and WaSH conditions, and the potential of the WaSH index as a monitoring tool by local policymakers to shrink the WaSH gaps.

The Use of Sanitary Latrines and the Practice of Open-Air Defecation in a Rural Setup in Perambalur District: A Cross-Sectional Study

Background Public health initiatives aim to decrease infectious diseases by enhancing sanitation, which is their primary goal. The practice of sporadically contaminating the environment with human feces has been around for generations and is embedded in the cultural behavior of villagers in India. This study aimed to estimate the proportion of people with access to latrine facilities and the proportion of people who practice open defecation in the villages of Perambalur, Tamil Nadu. Methodology This community-based, cross-sectional, analytical study was conducted in two rural villages in the Perambalur district for six months. After obtaining approval from the institutional ethics committee, we informed participants about the study's purpose. We conducted the study in selected rural areas and included every single residence in the hamlet, irrespective of whether the residents were permanent or temporary. We did not include families that were not reachable at any point during the survey. A convenient sampling procedure was used to select 330 houses for the study. The lead investigator interviewed one individual from each household, preferably the head of the family. A semi-structured questionnaire was used to collect the pertinent information. All collected data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and SPSS software version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the results. Results Only around 3.6% of the study participants lived in kutcha households, and about 99.1% of participants identified as Hindu. The proportion of household latrines used was 64.1% among the study participants. Of them, 52.3% engaged in open defecation. Only 4.7% of participants had access to an underground drainage system. Most participants gained knowledge from medical professionals (84.8%). Social media was the second most used source, accounting for about 60.7% of the total. The most frequent reason given for practicing open-air defecation was the perception that constructing restrooms would be expensive (76.3%), while the second most frequent reason was a lack of land (53.4%). An independent t-test found no statistically significant relationship between the availability of household latrines and the number of girls or boys, age, or family income. Compared to those living in semi-pucca and kutcha households, most participants (77.3%) who lived in pucca houses had household latrines. The chi-square test revealed that this proportional difference was statistically significant (p = 0.0001). Conclusions The study participants used household latrines 64.1% of the time. Of the participants, 52.3% engaged in open defecation. The government's initiative to build toilets has only helped a quarter of the population, which needs to be improved. Only 5% of people living in rural areas have access to an underground drainage system. The results of our study provide a justification for the government program's mandate that healthcare practitioners must deliver health education. Therefore, a personalized approach is required to overcome the behavioral barrier among rural people and achieve behavior change.

Household sanitation access and risk for non-marital sexual violence among a nationally representative sample of women in India, 2015-16

BACKGROUND

Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India.

METHODS

We analyzed 74,698 women age 15-49 from whom information on NMSV was collected in India's National Family Health Survey 2015-16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts.

RESULTS

We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p < 0.05). These findings persist after accounting for demographics including age and marital status, socio-economic factors related to marginalization (e.g., caste, wealth), women's employment, and the overall climate of the state.

CONCLUSION

Findings from this study support prior research suggesting that poor access to sanitation is associated with women's risk for NMSV in rural India. This may be via increased exposure, and/or as a marker for greater vulnerability to NMSV beyond what is explained by other SES indicators. Solutions can include increased access to private household sanitation and more targeted NMSV prevention in rural India.

Effectiveness of community and school-based sanitation interventions in improving latrine coverage: a systematic review and meta-analysis of randomized controlled interventions

Introduction

Approximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease.

Objective

Given that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access.

Methods

Eight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool.

Results

Eighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51–3.19, p < 0.05, I² = 97.28), latrine usage (OR 3.72, 95% CI 1.71–8.11, p < 0.05, I² = 91.52), latrine coverage or access (OR 3.95, 95% CI 2.08–7.50, p < 0.05, I² = 99.07), and improved latrine coverage or access (OR 3.68, 95% CI 1.52–8.91, p < 0.05, I² = 99.11). A combination of education and latrine construction was more effective compared to educational intervention alone.

Conclusion

Our study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-00934-4.

Latrine use practices and predictors in Rural Vietnam: Evidence from Giong Trom district, Ben Tre

PURPOSE

Rural Vietnam has been subject to continuous hygienic latrine interventions since the mid-1990s. However, most have concentrated on improving coverage rather than use. It is thus important to examine rural hygienic latrine use rates and the predictors impacting them. Accordingly, this can inform subsequent sanitation policy and enrich pertinent, rural health scholarship.

METHODS

For this study, 792 adult household heads were surveyed in Giong Trom district, Ben Tre, Mekong Delta region, Vietnam. A logistic regression analysis was performed on household heads owning a hygienic and unhygienic latrine simultaneously (N = 140). Included use predictors were individual-contextual and RANAS. This permit assessments of behavioural or normative predictors that, in many instances, are absent from comparable studies. Predictors' statistical significance was set at p < 0.03.

FINDINGS

Unsatisfactory hygienic latrine use in Ben Tre, among hygienic latrine owners, exceeds 20%. Many owners (26.8%) choose to retain their unhygienic latrine when acquiring a hygienic one, resulting in a 46.4% unhygienic latrine use rate within this sub-group. Meanwhile, the only hygienic latrine use predictors with statistical significance are neighbours' behaviour, user preference and health-benefit beliefs.

CONCLUSION

The Ben Tre case underscores that hygienic latrine ownership or access does not ensure comprehensive use. This even applies to latrines that are clean, working and adequate privacy-providing. Sanitation interventions thus ought to consider a targeted, community-coverage approach with expansive health messaging and emphasis on behavioural change. Demographic or socioeconomic-particular targeting, however, is not always necessary: no individual-contextual predictors proved statistically significant.

Impact of Swachh Bharat Abhiyan on Residents of Cochin Corporation

Context:

Environmental sanitation is a major public health issue in India. Sustainable Development Goal 6 envisages the accessibility of safe water and sanitation throughout the world. Swachh Bharat Abhiyan (SBA), a national cleanliness campaign established by the Government of India in 2014, has six main objectives. It has crossed the half-way point of its intended implementation course.

Aims:

This study aims to assess the impact of SBA on the sanitation of Cochin Corporation and to identify factors associated with awareness and practice of SBA.

Settings and Design:

A cross-sectional study among residents of Cochin Corporation.

Materials and Methods:

Semi-structured questionnaire was used to measure awareness, practice, and impact of SBA. Three divisions were selected purposively. A score was assigned for knowledge and impact assessment questions and was classified into three categories.

Statistical Analysis Used:

Descriptive statistics using frequencies and percentages were done. Chi-square test was used to test differences between proportions.

Results:

Thirty percent had no awareness regarding SBA and 42% had minimal awareness regarding the program and its objectives. Only 24% responded that SBA had a good impact on the overall sanitation of the community. The impact of SBA was significantly associated with socioeconomic status. The study revealed the major sanitary concern of the community to be the disposal of solid waste.

Conclusion:

The SBA did not have a significant impact on Cochin population due to existing good sanitation. Solid waste disposal is still a concern of the community. As far as, Kerala is concerned, it appears that the primary focus of SBA should be on Municipal Solid Waste Management.