Abstract
SummaryBackgroundUptake of Government-promoted sanitation remains a challenge in India. We aimed to investigate a low-cost, theory-driven, behavioural intervention designed to increase latrine use and safe disposal of child faeces in India.MethodsWe did a cluster-randomised controlled trial between Jan 30, 2018, and Feb 18, 2019, in 66 rural villages in Puri, Odisha, India. Villages were eligible if not adjacent to another included village and not designated by the Government to be open-defecation free. All latrine-owning households in selected villages were eligible. We assigned 33 villages to the intervention via stratified randomisation. The intervention was required to meet a limit of US$20 per household and included a folk performance, transect walk, community meeting, recognition banners, community wall painting, mothers’ meetings, household visits, and latrine repairs. Control villages received no intervention. Neither participants nor field assessors were masked to study group assignment. We estimated intervention effects on reported latrine use and safe disposal of child faeces 4 months after completion of the intervention delivery using a difference-in-differences analysis and stratified results by sex. This study is registered at ClinicalTrials.gov, NCT03274245.FindingsWe enrolled 3723 households (1807 [48·5%] in the intervention group and 1916 [51·5%] in the control group). Analysis included 14 181 individuals (6921 [48·8%] in the intervention group and 7260 [51·2%] in the control group). We found an increase of 6·4 percentage points (95% CI 2·0–10·7) in latrine use and an increase of 15·2 percentage points (7·9–22·5) in safe disposal of child faeces. No adverse events were reported.InterpretationA low-cost behavioural intervention achieved modest increases in latrine use and marked increases in safe disposal of child faeces in the short term but was unlikely to reduce exposure to faecal pathogens to a level necessary to achieve health gains.FundingThe Bill & Melinda Gates Foundation and International Initiative for Impact Evaluation.
Highlights
A lack of safe sanitation, including inconsistent use of available facilities, is a public health problem
We found an increase of 6·4 percentage points in latrine use and an increase of 15·2 percentage points (7·9–22·5) in safe disposal of child faeces
Bolstered by the Swachh Bharat Mission (SBM),[4] between 2000 and 2017, the proportion of the Indian population practicing open defecation decreased from 73% to 26% and the proportion using at least basic sanitation increased from 16% to 60%
Summary
A lack of safe sanitation, including inconsistent use of available facilities, is a public health problem. Open defecation and unsafe disposal of child faeces conta minate environments, enabling faecal-oral and helminth infections and insect vector diseases that might result in growth faltering, pneumonia, anaemia, impaired cognitive function, anti-microbial resistance, and death, as well as effects on wellbeing including mental health, safety, economic productivity, and school absence.[1,2]. An estimated 9% of the global population practices open defecation.[3]. Bolstered by the Swachh Bharat Mission (SBM),[4] between 2000 and 2017, the proportion of the Indian population practicing open defecation decreased from 73% to 26% and the proportion using at least basic sanitation increased from 16% to 60%.3. The Government of India declared India open-defecation free on the target date (Oct 2, 2019), the achievement has been questioned, including regarding access to and use of sanitation facilities.[5] Bolstered by the Swachh Bharat Mission (SBM),[4] between 2000 and 2017, the proportion of the Indian population practicing open defecation decreased from 73% to 26% and the proportion using at least basic sanitation increased from 16% to 60%.3 The Government of India declared India open-defecation free on the target date (Oct 2, 2019), the achievement has been questioned, including regarding access to and use of sanitation facilities.[5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
