Abstract
ObjectiveTo evaluate the long-term impact of a community-led total sanitation campaign in rural India.MethodsLocal organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016.FindingsIn 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (−6.8 percentage points; 95% CI: −13.1 to −1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes.ConclusionFuture research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change.
Highlights
Over 800 million people defecate in the open rather than use a toilet.[1]
Though global mortality from diarrhoeal diseases has recently declined,[1] poor water and sanitation are responsible for hundreds of thousands of child deaths, as well as high rates of diarrhoea, malnutrition and stunting.[2,3]
To begin to address these knowledge gaps, our study describes the evolution of latrine ownership, functionality, use and sanitation beliefs over 10 years following a community-led total sanitation intervention in Odisha state, India
Summary
Over 800 million people defecate in the open rather than use a toilet.[1]. Though global mortality from diarrhoeal diseases has recently declined,[1] poor water and sanitation are responsible for hundreds of thousands of child deaths, as well as high rates of diarrhoea, malnutrition and stunting.[2,3] Given the strong link between health, human development and productivity,[4] and the benefits of privacy, dignity and gender empowerment,[5] improving sanitation remains a key sustainable development goal.[6]. A second major gap is that few studies in the water, sanitation and hygiene sector have examined whether behaviour changes following an intervention are sustained in the long term. Several studies have rigorously evaluated the short-term behavioural and health impacts of sanitation interventions.[11,12,13,14,15,16] Yet recent systematic reviews[17,18,19,20,21] identified only one peer-reviewed sanitation evaluation with a control group that examined the impact beyond 3 years. A study in 1996 showed that while diarrhoea rates were lower 6 years after a water, sanitation and hygiene intervention, only 63.9% of the latrines (425 out of 665) remained functional.[22]
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