Purity, Pollution, and Space: Barriers to Latrine Adoption in Post-disaster India.

This study examines the adoption of latrines provided as part of reconstruction efforts after the 2004 tsunami in India. Primary data from 274 households encompassing 1154 individuals were collected from 14 villages. GLM and GLMM tests indicate that sex (more females adopted than males) is a statistically significant factor in latrine adoption (p = 0.046 and p = 0.005, respectively), while income, education, and male age cohorts were significant only in the GLM model. Regression analyses show that six social and demographic variables are somewhat predictive of latrine usage (R2 = 0.123). Thus, while quantitative methods provided a contextual summation, qualitative methods ultimately explained why individuals chose to adopt or abandon the latrines. Interviews (n = 76) and focus group discussions (n = 14) revealed that latrine adoption is influenced by cultural conceptualizations of purity, pollution, and space. For example, conceptualizations of purity and pollution led some households to deem latrines as profane and thus a barrier to the entry of gods, while spatial constraints forced others to convert latrine space to other beneficial uses (e.g., puja room and storage area). Finally, the cost of pumping septic tanks and shared infrastructure arose as barriers to latrine adoption. These barriers underscore the importance of economics as well as community demand, capacity, and cohesion in latrine adoption.

Considering the "public" in public health: popular resistance to the Smallpox Eradication Programme in India.

Public health initiatives, including large-scale vaccination and disease eradication programmes, regularly pit the rights of the individual against broader benefits to society. At times, the public resists such initiatives, with the World Health Organisation's Smallpox Eradication Programme (SEP) in India being a case in point. Here, we critically investigate resistance to smallpox vaccines in India and argue that while the SEP successfully eradicated a global killer; individuals were stripped of human rights through coercion, forcible vaccination and quarantine. In many cases, resistance to vaccination was linked to deep-rooted social, cultural and religious beliefs. Critical points made in this paper are applicable to contemporary discussions on required vaccinations, quarantine during the outbreak of diseases and the current campaign to eradicate polio.

The impact of rainfall and seasonal variability on the removal of bacteria by a point-of-use drinking water treatment intervention in Chennai, India.

Point-of-use water treatment has received widespread application in the developing world to help mitigate waterborne infectious disease. This study examines the efficacy of a combined filter and chemical disinfection technology in removing bacterial contaminants, and more specifically changes in its performance resulting from seasonal weather variability. During a 12-month field trial in Chennai, India, mean log-reductions were 1.51 for E. coli and 1.67 for total coliforms, and the highest concentration of indicator bacteria in treated water samples were found during the monsoon season. Analysis of variance revealed significant differences in the microbial load of indicator organisms (coliforms and E. coli) between seasons, storage time since treatment (TST), and samples with and without chlorine residuals. Findings indicate that the bacteriological quality of drinking water treated in the home is determined by a complex interaction of environmental and sociological conditions. Moreover, while the effect of disinfection was independent of season, the impact of storage TST on water quality was found to be seasonally dependent.

An assessment of boiling as a method of household water treatment in South India.

This article scrutinizes the boiling of water in Tamil Nadu and Puducherry, India. Boiling, as it is commonly practiced, improves water quality, but its full potential is not being realized. Thus, the objective is to refine the method in practice, promote acceptability, and foster the scalability of boiling and household water treatment (HWT) writ large. The study is based on bacteriological samples from 300 households and 80 public standposts, 14 focus group discussions (FGDs), and 74 household interviews. Collectively, the data fashion both an empirical and ethnographic understanding of boiling. The rate and efficacy of boiling, barriers to and caveats of its adoption, and recommendations for augmenting its practice are detailed. While boiling is scientifically proven to eliminate bacteria, data demonstrate that pragmatics inhibit their total destruction. Furthermore, data and the literature indicate that a range of cultural, economic, and ancillary health factors challenge the uptake of boiling. Fieldwork and resultant knowledge arrive at strategies for overcoming these impediments. The article concludes with recommendations for selecting, introducing, and scaling up HWT mechanisms. A place-based approach that can be sustained over the long-term is espoused, and prolonged exposure by the interveners coupled with meaningful participation of the target population is essential.