Prevalence of zero-sanitation in India: Patterns of change across the states and Union Territories, 1993-2021

Jain, Anoop; Kumar, Akhil; Kim, Rockli; Subramanian, S. V.

doi:10.7189/jogh.13.04082

Cited by 3 publications

References 41 publications

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Examining geographic variation in the prevalence of household drainage types across India in 2019-2021

Jain,

Harrison,

Kumar

et al. 2024

npj Clean Water

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The proportion of Indian households with access to a toilet has grown considerably over the past decade. Many of these toilets rely on on-site containment, either in the form of a septic tank or soak pit. If the waste from these containers is not removed using some type of mechanized method, it can overflow into drains before flowing into treatment facilities or being discharged into water bodies. Therefore, drains are a critical part of the sanitation chain. What remains unknown, however, is what types of drains are available to households in India. Understanding this is critical given that people are at a greater risk of ingesting contaminated water and making dermal contact with pathogens if waste flows in open drains. For the first time, India’s National Family Health Survey from 2019–2021 contains data on the type of drainage available to households. Thus, the purpose of this paper is to estimate the prevalence of households relying on no drainage, open drainage, drains to soak pits, and closed drainage. We also estimate these prevalence values for each of India’s 720 districts and by urban/rural communities to understand the geographic clustering of drainage types throughout India. Overall, we found that the most common drainage type was open drains (37.5% | 95% CI: 37.3–37.6), followed by closed drains (33.9% | 95% CI: 33.7–34.0). The household prevalence of open drainage was above 42% in more than half of India’s 720 districts. Similarly, the household prevalence of closed drainage was below 24% in more than half of India’s 720 districts. We also found that open drains were more common in rural communities, while closed drains were more common in urban communities. We also found a socioeconomic gradient in terms of drainage types, with those lower on the socioeconomic spectrum more likely to have open drains or no drainage. Our results underscore the need to both geographically and socioeconomically target interventions that ensure households have access to adequate drainage. Doing so is vital to remove contamination from the environment as a means of preventing morbidity.

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Examining geographic variation in the prevalence of household drainage types across India in 2019-2021

Jain,

Harrison,

Kumar

et al. 2024

npj Clean Water

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Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021

Jain,

Kim,

Swaminathan

et al. 2024

Int J Equity Health

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Background The health of India’s children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children. Methods We used data from five rounds of India’s National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities. Results The socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity. Conclusions Despite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India’s most vulnerable children.

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Utilization of improved sanitation facilities: Does socioeconomic inequality still persist in India?

Kumar,

Hasan,

Rajak

2024

Preprint

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Background Despite the significant improvement in sanitation coverage, utilization of improved sanitation still does not reach the optimal level across all socioeconomic groups in India. Given this backdrop, this study examines the socioeconomic status-related inequality in the utilization of improved sanitation facilities among Indian Households. Methods The study utilized fifth round of National Family Health Survey (NFHS); a national representative cross-sectional survey of India conducted in 2019-21. Logistic regression was applied to estimate the effect of various predictors on utilization of improved sanitation facilities. We also used decomposition analyse to identify the factors responsible for utilization of improved sanitation. Results The results indicate that 69% of Indian households utilized improved sanitation facilities. The study highlights that young and unmarried household heads, lower education, poor wealth status of household, living in rural areas, and marginalized castes had lower access to improved sanitation facilities. The multivariate regression analysis suggested that households belonging to richer [AOR: 13.99; 95%, CI: 13.64–14.34] and richest [AOR: 46.73; 95%, CI: 45.00–48.52] wealth quintiles have 14 and 47-times higher odds of having sanitation facility than households which belong to poorest quintile respectively. The decomposition analysis suggested that 11 to 18% of inequality was explained by the geographical region of household and caste of household head. The concentration curve of utilization of improved sanitation was more concentrated in Central and East India households (Concentration Index: 0.51 and 0.47), which has reduced to 0.17 and 0.22 during NFHS-4 to NFHS-5. We also found that 68 districts in India had less than 50 percent utilization of improved sanitation facilities. Conclusion The study concludes that households with a better socioeconomic status were more able to access improved sanitation. Thus, inclusive strategies are needed to reduce socioeconomic inequality at the micro level and strengthen ongoing policies.

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Prevalence of zero-sanitation in India: Patterns of change across the states and Union Territories, 1993-2021

Cited by 3 publications

References 41 publications

Examining geographic variation in the prevalence of household drainage types across India in 2019-2021

Examining geographic variation in the prevalence of household drainage types across India in 2019-2021

Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021

Utilization of improved sanitation facilities: Does socioeconomic inequality still persist in India?

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