Assessing the effectiveness of improved sanitation on diarrhoea and helminth infection: A cluster-randomized, controlled field trial In Orissa, India

Purpose

To provide rigorous evidence on the health impacts of demand-led efforts to end open defecation in India.

Activities

The main research question for the study was to assess the effectiveness of a rural household sanitation intervention to prevent diarrhoea, soil-transmitted helminth infection, and child malnutrition. The primary outcomes of the study included 7-day prevalence of reported diarrhoea in children younger than 5 years and the secondary binary health outcomes (all age diarrhoea prevalence, helminths). Secondary health outcomes included Health of age z scores (HAZ) and weight for age Z scores (WAZ) were used. Geographic data were used to support a range of exploratory analyses accounting for actual latrine uptake, by geo referencing and mapping.

This study used a cluster-randomised controlled trial (RCT) design which was conducted between May 20, 2010, and Dec 22, 2013, in 100 rural villages in Odisha, India. Households within villages were eligible if they had a child younger than 4 years or a pregnant woman. Villages were randomly assigned (1:1), with a computer-generated sequence, to undergo latrine promotion and construction or to receive no intervention (control).

Increased latrine coverage is generally believed to be effective for reducing exposure to faecal pathogens and preventing disease; however, our results show that this outcome cannot be assumed. As efforts to improve sanitation are being undertaken worldwide, approaches should not only meet international coverage targets, but should also be implemented in a way that achieves uptake, reduces exposure, and delivers genuine health gains.

Countries of activity

Location of main activity

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Behaviour change Bill & Melinda Gates Foundation East Asia & Pacific Health and hygiene Public awareness, advocacy and civil society engagement Rural Rural areas Specific to one or several countries University, education or research institution

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