Spatial clustering and drivers of open defecation practice in India: Findings from the fifth round of National Family Health Survey (2019-21)

Roy, Avijit; Rahaman, Margubur; Bannerji, Rohit; Adhikary, Mihir; Kapasia, Nanigopal; Chouhan, Pradip; Das, Kailash Chandra

doi:10.1016/j.glt.2023.05.002

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Accordingly, as the percentage of rural residents in the EAs was high, the prevalence of OD also increased. This was supported by similar studies conducted in India [ 7 , 8 ]. Regions such as Tigray, Afar, Amhara, Benishangul Gumuz, and the northern Oromia regions were explored to have a higher influence of rural residency on OD, while regions with a lower effect of rural residency on OD were found in Addis Ababa, SNNPR, Gambela, and the Somali regions.…”

Section: Discussionsupporting

confidence: 81%

“…This was mainly because nomadic way of life standards, high rural-urban disparity, poverty-related factors, and poor health extension package (HEP) implementation, monitoring, and evaluation in the highly concentrated areas. This was also supported by a study conducted in India [ 7 , 8 ]. Recent evidence showed that households that owned the designed toilets preferred OD due to many reasons, like cultural and attitude-related factors, a lack of awareness, and having a large family size in the above areas [ 37 ].…”

Section: Discussionsupporting

confidence: 71%

“…The possible variation could be cultural influence, limited knowledge, and awareness about the consequences of OD among people with no education, and poor monitoring and regulation in those areas, especially poor implementations of health extension. This finding was supported by a study in Kenya [ 34 , 42 ], Nigeria [ 43 ], Haiti [ 28 ], and India [ 7 , 8 ], which revealed OD was associated with no education among households.…”

Section: Discussionsupporting

confidence: 59%

“…However, the current prevalence of OD is still the highest in eastern Africa, and Ethiopia is not on the best track to achieve the SDG goal of being open defecation-free in 2030. On the other hand, this study was higher than studies conducted in Kenya (10%) [ 34 ], a recent study in Haiti (20%) [ 5 ], in south Asian countries such as India (20%) [ 7 , 8 ], Bangladesh (1.2%) [ 9 ], Nepal (7%) [ 35 ], and Pakistan (16%) [ 36 ]. The possible variation could be because of cultural influence, socio-economic variations like poverty, weak rules and regulations, and the absence of monitoring for sustainability after a designated latrine.…”

Section: Discussioncontrasting

confidence: 54%

“…Recent evidence shows that the burden of OD in the South Asian region is 44%, which is mainly accounted for by India. In India, a recent study revealed that 20% of HHs practiced OD [ 7 , 8 ]. In south Asian countries, the recent prevalence of OD practice ranged from 1.2% in Bangladesh [ 9 ] to 19% in India [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Spatial variation and geographical weighted regression analysis to explore open defecation practice and its determinants among households in Ethiopia

Derseh,

Alemayehu,

Agimas

et al. 2024

PLoS ONE

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Background In Ethiopia, recent evidence revealed that over a quarter (27%) of households (HHs) defecated openly in bush or fields, which play a central role as the source of many water-borne infectious diseases, including cholera. Ethiopia is not on the best track to achieve the SDG of being open-defecation-free by 2030. Therefore, this study aimed to explore the spatial variation and geographical inequalities of open defecation (OD) among HHs in Ethiopia. Methods This was a country-wide community-based cross-sectional study among a weighted sample of 8663 HHs in Ethiopia. The global spatial autocorrelation was explored using the global Moran’s-I, and the local spatial autocorrelation was presented by Anselin Local Moran’s-I to evaluate the spatial patterns of OD practice in Ethiopia. Hot spot and cold spot areas of OD were detected using ArcGIS 10.8. The most likely high and low rates of clusters with OD were explored using SaTScan 10.1. Geographical weighted regression analysis (GWR) was fitted to explore the geographically varying coefficients of factors associated with OD. Results The prevalence of OD in Ethiopia was 27.10% (95% CI: 22.85–31.79). It was clustered across enumeration areas (Global Moran’s I = 0.45, Z-score = 9.88, P-value ≤ 0.001). Anselin Local Moran’s I analysis showed that there was high-high clustering of OD at Tigray, Afar, Northern Amhara, Somali, and Gambela regions, while low-low clustering of OD was observed at Addis Ababa, Dire-Dawa, Harari, SNNPR, and Southwest Oromia. Hotspot areas of OD were detected in the Tigray, Afar, eastern Amhara, Gambela, and Somali regions. Tigray, Afar, northern Amhara, eastern Oromia, and Somali regions were explored as having high rates of OD. The GWR model explained 75.20% of the geographical variation of OD among HHs in Ethiopia. It revealed that as the coefficients of being rural residents, female HH heads, having no educational attainment, having no radio, and being the poorest HHs increased, the prevalence of OD also increased. Conclusion The prevalence of OD in Ethiopia was higher than the pooled prevalence in sub-Saharan Africa. Tigray, Afar, northern Amhara, eastern Oromia, and Somali regions had high rates of OD. Rural residents, being female HH heads, HHs with no educational attainment, HHs with no radio, and the poorest HHs were spatially varying determinants that affected OD. Therefore, the government of Ethiopia and stakeholders need to design interventions in hot spots and high-risk clusters. The program managers should plan interventions and strategies like encouraging health extension programs, which aid in facilitating basic sanitation facilities in rural areas and the poorest HHs, including female HHs, as well as community mobilization with awareness creation, especially for those who are uneducated and who do not have radios.

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Section: Discussionsupporting

confidence: 81%