Heather Reese1, Parimita Routray2, Belen Torondel2, Sheela S Sinharoy1, Samir Mishra3, Matthew C Freeman1, Howard H Chang4, Thomas Clasen1,2. 1. Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 2. Environmental Health Group, London School of Hygiene and Tropical Medicine, London, UK. 3. Kalinga Institute of Industrial Technology, Bhubaneswar, India. 4. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Abstract
BACKGROUND: Open defecation is widespread in rural India, and few households have piped water connections. While government and other efforts have increased toilet coverage in India, and evaluations found limited immediate impacts on health, longer-term effects have not been rigorously assessed. METHODS: We conducted a matched cohort study to assess the longer-term effectiveness of a combined household-level piped water and sanitation intervention implemented by Gram Vikas (an Indian NGO) in rural Odisha, India. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least 5 years before, and matched to 45 control villages. We conducted surveys and collected stool samples between June 2015 and October 2016 in households with a child <5 years of age (n = 2398). Health surveillance included diarrhoea (primary outcome), acute respiratory infection (ARI), soil-transmitted helminth infection, and anthropometry. RESULTS: Intervention villages had higher improved toilet coverage (85% vs 18%), and increased toilet use by adults (74% vs 13%) and child faeces disposal (35% vs 6%) compared with control villages. There was no intervention association with diarrhoea [adjusted OR (aOR): 0.94, 95% confidence interval (CI): 0.74-1.20] or ARI. Compared with controls, children in intervention villages had lower helminth infection (aOR: 0.44, 95% CI: 0.18, 1.00) and improved height-for-age z scores (HAZ) (+0.17, 95% CI: 0.03-0.31). CONCLUSIONS: This combined intervention, where household water connections were contingent on community-wide household toilet construction, was associated with improved HAZ, and reduced soil-transmitted helminth (STH) infection, though not reduced diarrhoea or ARI. Further research should explore the mechanism through which these heterogenous effects on health may occur.
BACKGROUND: Open defecation is widespread in rural India, and few households have piped water connections. While government and other efforts have increased toilet coverage in India, and evaluations found limited immediate impacts on health, longer-term effects have not been rigorously assessed. METHODS: We conducted a matched cohort study to assess the longer-term effectiveness of a combined household-level piped water and sanitation intervention implemented by Gram Vikas (an Indian NGO) in rural Odisha, India. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least 5 years before, and matched to 45 control villages. We conducted surveys and collected stool samples between June 2015 and October 2016 in households with a child <5 years of age (n = 2398). Health surveillance included diarrhoea (primary outcome), acute respiratory infection (ARI), soil-transmitted helminth infection, and anthropometry. RESULTS: Intervention villages had higher improved toilet coverage (85% vs 18%), and increased toilet use by adults (74% vs 13%) and child faeces disposal (35% vs 6%) compared with control villages. There was no intervention association with diarrhoea [adjusted OR (aOR): 0.94, 95% confidence interval (CI): 0.74-1.20] or ARI. Compared with controls, children in intervention villages had lower helminth infection (aOR: 0.44, 95% CI: 0.18, 1.00) and improved height-for-age z scores (HAZ) (+0.17, 95% CI: 0.03-0.31). CONCLUSIONS: This combined intervention, where household water connections were contingent on community-wide household toilet construction, was associated with improved HAZ, and reduced soil-transmitted helminth (STH) infection, though not reduced diarrhoea or ARI. Further research should explore the mechanism through which these heterogenous effects on health may occur.
Authors: Joshua V Garn; Jennifer L Wilkers; Ashley A Meehan; Lisa M Pfadenhauer; Jacob Burns; Rubina Imtiaz; Matthew C Freeman Journal: Cochrane Database Syst Rev Date: 2022-06-21
Authors: Jennyfer Wolf; Sydney Hubbard; Michael Brauer; Argaw Ambelu; Benjamin F Arnold; Robert Bain; Valerie Bauza; Joe Brown; Bethany A Caruso; Thomas Clasen; John M Colford; Matthew C Freeman; Bruce Gordon; Richard B Johnston; Andrew Mertens; Annette Prüss-Ustün; Ian Ross; Jeffrey Stanaway; Jeff T Zhao; Oliver Cumming; Sophie Boisson Journal: Lancet Date: 2022-07-02 Impact factor: 202.731
Authors: Sitara S R Ajjampur; Saravanakumar Puthupalayam Kaliappan; Katherine E Halliday; Gokila Palanisamy; Jasmine Farzana; Malathi Manuel; Dilip Abraham; Selvi Laxmanan; Kumudha Aruldas; Anuradha Rose; David S Kennedy; William E Oswald; Rachel L Pullan; Sean R Galagan; Kristjana Ásbjörnsdóttir; Roy M Anderson; Jayaprakash Muliyil; Rajiv Sarkar; Gagandeep Kang; Judd L Walson Journal: PLoS Negl Trop Dis Date: 2021-04-30
Authors: Gloria D Sclar; Valerie Bauza; Hans-Joachim Mosler; Alokananda Bisoyi; Howard H Chang; Thomas F Clasen Journal: BMC Public Health Date: 2022-01-15 Impact factor: 3.295
Authors: Belen Torondel; Jane Ferma; Suzanna C Francis; Bethany A Caruso; Parimita Routray; Heather Reese; Thomas Clasen Journal: Int J Hyg Environ Health Date: 2021-10-23 Impact factor: 5.840
Authors: Frederick G B Goddard; Radu Ban; Dana Boyd Barr; Joe Brown; Jennifer Cannon; John M Colford; Joseph N S Eisenberg; Ayse Ercumen; Helen Petach; Matthew C Freeman; Karen Levy; Stephen P Luby; Christine Moe; Amy J Pickering; Jeremy A Sarnat; Jill Stewart; Evan Thomas; Mami Taniuchi; Thomas Clasen Journal: Environ Sci Technol Date: 2020-09-09 Impact factor: 9.028