BackgroundThe most ambitious sanitation campaign to end open defecation (OD) in India came to a close on 2 October 2019 and there are limited independent, robust data to measure its success. We aimed to evaluate Rajasthan’s claim of open defecation free status in March 2018 under the Swachh Bharat Mission (SBM) or ‘Clean India Mission’ by measuring OD trends from 2016 to 2018.MethodsWe used publicly available data from Performance Monitoring and Accountability 2020, a representative survey with two-stage stratified cluster sampling. Enumeration areas were the primary sampling units selected by the probability proportional ­to ­size method. The repeated cross-sectional surveys independently collected household water and sanitation data in Rajasthan (n=20 485). Among households reporting toilet access, the data were pooled across the four rounds for an observational analysis using logistic regression. The primary outcome measure was regular OD among households with access to toilet facilities.FindingsBetween October 2016 and July 2018 main OD practices in rural Rajasthan households decreased from 63.3% (95% CI 57.0% to 69.6%) to 45.8% (95% CI 38.4% to 53.2%) and in urban households from 12.6% (95% CI 6.0% to 19.1%) to 9.4% (95% CI 4.0% to 14.7%). Households with regular OD occurring despite access to a toilet made up 21.7% (95% CI 16.9% to 26.6%) of rural and 12.1% (95% CI 3.6% to 20.7%) of urban Rajasthan as of July 2018. The multivariate logistic regression revealed that factors related to water stress and sanitation sharing were associated with household members regularly practising OD.ConclusionsThese data highlight the importance of a continued focus on constructing toilets that are affordable with low water requirements during the next phase of SBM. An independent survey that can provide robust estimates of OD is needed to monitor progress of toilet construction and use.

Background: Mobility is an important risk determinant for HIV given the potential for intermittent access to HIV services. Mobility may be particularly relevant among female sex workers, (FSW) who have been shown to be at high risk for HIV in settings around the world. Data regarding the role mobility plays in exacerbating HIV risks among FSW across Sub-Saharan Africa remains limited, and data on FSW in Guinea-Bissau is sparse.Methods: FSW in four regions of Guinea-Bissau were recruited with a respondent-driven sampling (RDS) method and participated in an integrated bio-behavioral survey. Associations between reported mobility and social and HIV vulnerabilities among FSW in Guinea-Bissau were assessed using multivariable logistic regression models. Results: 34.8% of respondents reported mobility to one location and 15.7% reported mobility to more than one location within the past six months. Statistical analysis demonstrated that mobility to more than one destination was significantly associated with recent sex without a condom with both clients (aOR: 2.57 (95% CI: 1.10, 6.00)) and non-paying partners (aOR: 4.73 (95% CI: 2.24, 10.02)) compared to non-mobility. However, mobility to one or more locations was also associated with higher odds of receiving HIV prevention information (mobility to one location: aOR: 1.63 (95% CI: 1.07, 2.49); mobility to >1 location: aOR: 2.34 (95% CI: 1.28,4.26)) and mobility to more than one location was associated with more engagement with HIV-related organizations (aOR: 2.26 (95% CI: 1.27, 4.04)).Conclusions: These results suggest that while some prevention services including HIV prevention information reach mobile FSW in Guinea-Bissau, HIV prevention needs remain unmet for mobile FSW in Guinea-Bissau.

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