Transition in availability of improved sanitation facilities and its effect on diarrhoeal disease in India: evidence from longitudinal data.

BACKGROUND: Poor sanitation, such as open defecation, is a major public health concern in India, causing diarrhoea and other infectious diseases. So far, few studies have linked poor sanitation with diarrhoea using longitudinal data. In this context, this study assesses the transition in availability of household sanitation facilities and its effect on diarrhoeal morbidity. METHODS: We used two waves of longitudinal data from the India Human Development Survey, conducted in 2004-2005 and 2011-2012, and based on 34 131 followed-up households using a two-stage stratified random sampling method. In the first stage, multinomial logistic regression was used to assess socio-economic factors contributing to the transition in the availability of household sanitation facilities. In the second stage, multivariate linear regression was performed to examine the effect of the change in the availability of household sanitation facilities on the prevalence of diarrhoeal morbidity. All the analysis in this study was carried out by using Stata version 13 software. RESULTS: The findings reveal that the practice of open defecation was continued to be higher among lower socio-economic households than better-off socio-economic households in both 2004-2005 and 2011-2012. The proportion of household members who fell sick due to diarrhoea morbidity has decreased significantly (ß=-0.06, p<0.04) among households that switched from open defecation in 2004-2005 to improved sanitation facilities in 2011-12, compared to households that continued to practice open defecation in both periods (2004-2005 and 2011-2012). The share of household members who fell sick due to diarrhoeal morbidity was significantly lower (ß=-0.09, p<0.001) among the households who adopted improved toilet facilities in both periods (2004-2005 and 2011-2012) as compared with the households who continued to defecate openly in both periods, net of other covariates. CONCLUSIONS: Our findings show that there is a need to strengthen existing policies focusing on lower socio-economic groups to improve sanitation and eliminate its related diseases. In particular, the ongoing 'Clean India Mission' should play a critical role in promoting sanitation for all.

Impact of change in household environment condition on morbidity in India: Evidence from longitudinal data.

BACKGROUND: Household environment condition is an important predictor of morbidity of the household members. Without forming a healthy household environment, creating a healthy population is not possible. In this background, this study assesses the impact of change in household environment conditions on morbidity. METHODS: For the empirical analysis purpose of this study, we used two waves of longitudinal data from India Human Development Survey (2004-05, 2011-12). This study is based on 34131 re-contacted households in 2011-12 from the base year 2005. The bivariate and ANOVA tests were performed to assess any short-term morbidity (diarrhoea, fever and cough) with respect to change in household environment condition from 2005 to 2011. The multivariate linear regression was performed to assess the impact of change in household environment conditions on morbidity. The multinomial logistic regression was used to assess the impact of change in household environment condition on change in morbidity. RESULTS: The results from multivariate linear regression have shown that the share of household members fell sick due to any short-term morbidity (ASM) was significantly lower (ß = -0.060, P<0.001) among the households who lived in clean environment condition in both the periods, 2004-05 and in 2011-12 as compared to those who were living in poor environment condition in both periods net of other socio-economic characteristics of the households. The share of household members fell sick due to any short-term morbidity has significantly declined (ß = -0.051, P<0.001) among the household whose household environment condition has changed from poor in 2004-05 to clean environment in 2011-12 as compared to the households who have lived in poor environment condition in both periods in 2004-05 and 2011-12. The results of adjusted percentage from multinomial logistic regression have shown that the household members who fell sick with ASM was remained higher (4.9%; P<0.05) among the households whose environment condition was remained poor in both years in 2005 and 2011 as compared to the other households (2.7%) who remained in the better-off condition in both years in 2005 and 2011. CONCLUSION: Considering the findings of the study, we suggest that ongoing government flagships programmes such as Swacch Bharat Mission (Clean India Mission), Pradhan Mantri Ujjwala Yojana (Prime Minister Clean Energy Scheme) and Pradhan Mantri Awas Yojana (Prime Minister Housing Scheme), and Jal Jeevan Mission (Improved Source of Drinking Water Scheme) should work in tandem to improve household environment conditions.