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Bias in the perceived prevalence of open defecation: Evidence from Bihar, India.

ABSTRACT: People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people's perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.

SUBMITTER: Kuang J

PROVIDER: S-EPMC7485860 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Bias in the perceived prevalence of open defecation: Evidence from Bihar, India.

Kuang Jinyi J Thulin Erik E Ashraf Sania S Shpenev Alex A Das Upasak U Delea Maryann G MG McNally Peter P Bicchieri Cristina C

PloS one 20200911 9

People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people's perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we ...[more]

PMID: 32915831

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Project description:ObjectivesTo investigate differences in reported open defecation between a question about latrine use or open defecation for every household member and a household-level question.SettingRural 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.ParticipantsIn 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?ResultsWe 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.ConclusionsWe 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 numberRegistry for International Development Impact Evaluations (5b55458ca54d1).

Project description:BackgroundIn sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation. This practice facilitates the transmission of diarrheal diseases - one of the leading causes of mortality in children under 5 in sub-Saharan Africa. The main purpose of this study is to: estimate changes in open defecation prevalence between 2005 and 2010 across countries in sub-Saharan Africa; examine the association between national level indices and changes in open defecation prevalence; and assess how many countries can achieve 'open defecation free status' by 2015.MethodsAfter applying selection criteria, this study analyzed country-level data for 34 sub-Saharan African countries. Seven country-level indices were collected: 1) presence of a national sanitation policy; 2) budget line for sanitation; 3) budget allocated to sanitation; 4) annual per capita GDP; 5) GDP growth; 6) implementation of total sanitation approaches; and 7) per capita aid disbursement for water supply and sanitation. The relationships between these country-level indices and the change in open defecation from 2005 to 2010 were investigated using Wilcoxon Signed-Rank test and Spearman's rank correlation test.ResultsOnly 3 countries (i.e. Ethiopia, Angola and Sao Tome and Principe) decreased open defecation by 10% or more between 2005 and 2010. No significant associations were observed between the change in open defecation prevalence and all of national level indices except per capita aid disbursement. Per capita aid disbursement for water and sanitation was positively associated with a reduction in open defecation (p-value?=?0.02) for a subset of 29 low-income countries from 2005 to 2010. Only one country in our analysis, Angola, is on track to end open defecation by 2015 based on their performance between 2000 and 2010.ConclusionsMost of the national level indices, including a country's economic status, were not associated with the change in the open defecation prevalence. Based on current trends, the goal of ending open defecation in the majority of sub-Saharan African countries by 2015 will not be achieved. Our findings may be limited by the exploratory nature of this analysis, and future research is required to identify and characterize national level factors specific to reducing open defecation in sub-Saharan Africa.

Project description:BackgroundSoil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions.MethodsA cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored.ResultsIn January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection.ConclusionsSTH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases.

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.

Dataset Information

Bias in the perceived prevalence of open defecation: Evidence from Bihar, India.

Publications

Bias in the perceived prevalence of open defecation: Evidence from Bihar, India.

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