Dataset Information

Measuring open defecation in India using survey questions: evidence from a randomised survey experiment.

ABSTRACT: OBJECTIVES:To investigate differences in reported open defecation between a question about latrine use or open defecation for every household member and a household-level question. SETTING:Rural India is home to most of the world's open defecation. India's Demographic and Health Survey (DHS) 2015-2016 estimates that 54% of households in rural India defecate in the open. This measure is based on a question asking about the behaviour of all household members in one question. Yet, studies in rural India find substantial open defecation among individuals living in households with latrines, suggesting that household-level questions underestimate true open defecation. PARTICIPANTS:In 2018, we randomly assigned latrine-owning households in rural parts of four Indian states to receive one of two survey modules measuring sanitation behaviour. 1215 households were asked about latrine use or open defecation individually for every household member. 1216 households were asked the household-level question used in India's DHS: what type of facility do members of the household usually use? RESULTS:We compare reported open defecation between households asked the individual-level questions and those asked the household-level question. Using two methods for comparing open defecation by question type, the individual-level question found 20-21 (95% CI 16 to 25 for both estimates) percentage points more open defecation than the household-level question, among all households, and 28-29 (95% CI 22 to 35 for both estimates) percentage points more open defecation among households that received assistance to construct their latrines. CONCLUSIONS:We provide the first evidence that individual-level questions find more open defecation than household-level questions. Because reducing open defecation in India is essential to meeting the Sustainable Development Goals, and exposure to open defecation has consequences for child mortality and development, it is essential to accurately monitor its progress. TRIAL REGISTRATION NUMBER:Registry for International Development Impact Evaluations (5b55458ca54d1).

SUBMITTER: Vyas S

PROVIDER: S-EPMC6773353 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Measuring open defecation in India using survey questions: evidence from a randomised survey experiment.

Vyas Sangita S Srivastav Nikhil N Mary Divya D Goel Neeta N Srinivasan Sujatha S Tannirkulam Ajaykumar A Ban Radu R Spears Dean D Coffey Diane D

BMJ open 20190926 9

<h4>Objectives</h4>To investigate differences in reported open defecation between a question about latrine use or open defecation for every household member and a household-level question.<h4>Setting</h4>Rural India is home to most of the world's open defecation. India's Demographic and Health Survey (DHS) 2015-2016 estimates that 54% of households in rural India defecate in the open. This measure is based on a question asking about the behaviour of all household members in one question. Yet, st ...[more]

PMID: 31558454

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Project description:Our group conducted a cluster-randomised trial in 100 villages of Orissa, India to measure the impact of a rural sanitation intervention implemented under the government of India's Total Sanitation Campaign, on diarrhoea and soil-transmitted helminth infections. This paper reports on a process evaluation conducted in the context of the trial.Process evaluation data were collected through review of key documentation, quantitative surveys, direct observations, and semi-structured interviews with staff from implementing NGOs and community members. Between March 2011 and March 2012, trained enumerators recorded observations on latrine construction status every 6-8 weeks in the 50 intervention villages and noted activities reported to have taken place based on NGO staff interviews and review of NGO records. A survey among 10% of households in intervention and control villages was conducted to compare levels of awareness of key intervention components. In addition, 10% of village water and sanitation committee (VWSC) members were interviewed to measure their level of involvement in the intervention delivery.The percentage of households with a latrine (completed or under construction) increased from 8% at baseline to 66% one year after the start of the intervention in March 2012. Almost none of the intervention households recall any form of participatory community-level activities at the start of the programme, although intervention households were generally more aware of the Total Sanitation Campaign (91% versus 49%, p?<?0.001), VWSCs (51% versus 9%, p?<?0.001), adolescent girls groups (23% versus 8%, p?<?0.01), wall paintings (44% versus 7%, p?<?0.001) and were more likely to report a household visit on sanitation during the past three months (65% versus 3%, p?<?0.001). We found no strong evidence of an association between levels of awareness of or participation in mobilisation activities and levels of latrine coverage in intervention villages.The levels of coverage achieved and the levels of awareness of the mobilisation process in our intervention villages were lower than planned, but similar to those reported elsewhere in India under the TSC. Our process evaluation highlights important gaps between the TSC guidelines and their implementation on the ground.Number on clinicaltrial.gov: NCT01214785.

Project description:ObjectiveThe study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India.DesignThe present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019-2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots.Setting and participantsThe study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India.Primary and secondary outcome measuresThe outcome measure was the prevalence of OD.ResultsThe prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural-urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%).ConclusionThe practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.

Dataset Information

Measuring open defecation in India using survey questions: evidence from a randomised survey experiment.

Publications

Measuring open defecation in India using survey questions: evidence from a randomised survey experiment.

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