Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

Abstract

IntroductionGovernment efforts to address massive shortfalls in rural water and sanitation in India have centred on construction of community water sources and toilets for selected households. However, deficiencies with water quality and quantity at the household level and community coverage and actual use of toilets have led Gram Vikas, a local non-governmental organization in Odisha, India, to develop an approach that provides household-level piped water connections contingent on full community-level toilet coverage.MethodsThis matched cohort study was designed to assess the effectiveness of a combined piped water and sanitation intervention. Households with children <5 years in 45 randomly selected intervention villages and 45 matched control villages will be followed over 17 months. The primary outcome is prevalence of diarrhoeal diseases; secondary health outcomes include soil-transmitted helminth infection, nutritional status, seroconversion to enteric pathogens, urogenital infections and environmental enteric dysfunction. In addition, intervention effects on sanitation and water coverage, access and use, environmental fecal contamination, women's empowerment, as well as collective efficacy, and intervention cost and cost-effectiveness will be assessed.Ethics and disseminationThe study protocol has been reviewed and approved by the ethics boards of the London School of Hygiene and Tropical Medicine, UK and KIIT University, Bhubaneswar, India. Findings will be disseminated via peer-reviewed literature and presentation to stakeholders, government officials, implementers and researchers.Trial registration numberNCT02441699.

Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India

“…This sub-study was nested within a matched cohort study evaluating the effectiveness of a household-level piped water and sanitation intervention implemented with complete community coverage in rural Odisha, India. Forty-five control villages were matched with 45 randomly selected intervention villages in the Ganjam and Gajapati districts of Odisha using a matching process that balanced control and intervention arms described in detail in Reese et al 29 Within each village, up to 40 households with children less than 5 years of age were randomly selected to be enrolled in the study. The intervention takes an average of 3 years to fully implement and was started in villages between 2003 and 2006.…”

“…As described by Reese et al, 29 the MANTRA intervention implemented by Gram Vikas included components of WASH, including 1) household piped water, 2) household pour-flush toilet, and 3) a bathing room attached to the toilet. The piped water was connected to the toilet, bathing room, and kitchen, and the toilet was equipped with dual soak-away pits.…”

Water, Sanitation, and Hygiene (WASH) Conditions and Their Association with Selected Diseases in Urban India

“…The literature suggests that WASH conditions are significantly associated with infectious diseases. A number of studies have explored sanitation conditions (Kumar, 2015;Dobe, Sur & Biswas, 2011;Gupta & Pal, 2008;Nath, 2003) and their association with health at micro and national levels (Reese et al , 2017;Baranwal, Baranwal, & Roy, 2014;Kumar & Das, 2014;Kumar & Harada, 2002;Gupta & Pal, 2008;Puri, Kumar & Johal, 2008). However, there have been no studies focusing on WASH practices and their link with selected diseases in urban households in India.…”

“…However, there have been no studies focusing on WASH practices and their link with selected diseases in urban households in India. Previous studies have brought out significant disparities in WASH conditions in rural versus urban settings concerning access to sanitation facilities (Reese et al, 2017;Das & Das, 2015). The relationship between WASH and the prevalence of diseases in urban settings is still unexplored at the national level.…”

Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools

“…For instance, program implementers can work to improve the understanding that having access to and exclusively using an improved sanitation facility fulfills a relational obligation that people in a community have to each other in terms of their contributions to a common interest (e.g., open defecation free status, sanitary community environment). Alternatively, program implementers can require community-level sanitation (e.g., predetermined coverage level and exclusive use) prior to working with a community to install or develop communal infrastructure that is endogenously perceived of as a public good, such as a community water source or water distribution system [46].…”