The Effect of India's Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial

Abstract

Sumeet Patil and colleagues conduct a cluster randomized controlled trial to measure the effect of India's Total Sanitation Campaign in Madhya Pradesh on the availability of individual household latrines, defecation behaviors, and child health. Please see later in the article for the Editors' Summary

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

“…Studies that reached high latrine coverage and with long-term follow-up [10] resulted in higher impact on prevalence and incidence, compared to studies achieving low latrine coverage [16] and high levels of continued open defecation [15].…”

“…Apart from access to sanitation facilities, attitudes towards defecation and hygiene practices, acceptance and (appropriate) use of these infrastructures are key determinants for discontinuation of open defecation and thus successful interruption of faecal contamination of the environment [15,16]. Our findings showed high proportion of behaviour change within the intervention communities with considerably reduced reported open defecation in general (before: 95.8%, after: 44.6%), going hand-in-hand with an increase in stated toilet use (before: 15.5%, after: 94.6%).…”

“…It is important to note that measurability of protective effects from sanitation interventions depends on social-ecological contexts (e.g. resource-scarce environment vs area with improved facilities at baseline [14], rural vs urban [15]), latrine coverage [16] and how rigorously interventions were implemented (such as elimination of open defecation vs increase of latrine ownership) [17]. Prior research underscores the importance of integrated approaches for effective control of helminthiases and diarrhoeal diseases [18][19][20].…”

Toilets Can Work: Short and Medium Run Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation

“…However, interventions promoting on-site sanitation without sewerage, as is typically implemented in rural and other low-density settings, have not been as effective as sewerage (Wolf et al 2014). Two recent cluster-randomized trials evaluating sanitation-only interventions in rural India, one in Orissa ) and the other in Madhya Pradesh (Patil et al 2014) find only modest impacts of latrine construction on latrine usage, and no impacts on health.…”

“…However, interventions promoting on-site sanitation without sewerage, as is typically implemented in rural and other low-density settings, have not been as effective as sewerage (Wolf et al 2014). Two recent cluster-randomized trials evaluating sanitation-only interventions in rural India, one in Orissa ) and the other in Madhya Pradesh (Patil et al 2014) find only modest impacts of latrine construction on latrine usage, and no impacts on health.Part of the issue is that these sanitation-focused efforts have not fully taken on board two factors that play a key role in water and sanitation: complementarities and externalities. Epidemiological complementarities between water and sanitation interventions may arise because there are multiple pathways for transmission of water-borne disease (Clasen et al 2007, Waddington andSnilstveit 2009).…”