Total Sanitation Lacks Thrust in Odisha: Study

BHUBANESWAR: Increasing coverage of the Total Sanitation Campaign (TSC) and equipping more number of households with latrines has not guaranteed the health benefits associated with sanitation. TCS, the world’s largest sanitation initiative, might be taking giant strides in enhancing access to latrines in India. But, it has not brought any significant reduction in exposure to faecal pathogens or decreased occurrence of diarrhoea, parasitic worm infections or child malnutrition, an extensive study in rural Odisha published in the latest issue of the prestigious ‘Lancet Global Health’ journal has found.

The study led by Professor Thomas Clasen from Emory University, Atlanta, USA and the London School of Hygiene and Tropical Medicine, UK, in collaboration with Department of Civil and Environmental Engineering, University of California-Davis, USA, Xavier University, Bhubaneswar and School of Biotechnology, KIIT University, Bhubaneswar, took into consideration about 100 villages in Puri district.

Involving as many as 9,480 households with at least one child below four years or a pregnant women, the study conducted from mid-2010 to 2013-end has brought the perception-busting facts to the fore. Households in half the villages were randomly assigned for immediate sanitation interventions while others were controlled to receive such interventions after a 14-month surveillance period.

During the study period, average proportion of households with latrine in intervention villages increased from nine per cent to 63 per cent compared to 12 per cent from eight per cent in control villages. However, researchers found no evidence that access to latrines protected against diarrhoea in children. Week-long prevalence of diarrhoea reported among children in intervention group was 8.8 per cent while it was 9.1 per cent in control group.

What is more, the intervention also did not reduce prevalence of parasitic worms that are transmitted through soil and affect physical growth and lead to impaired cognitive function in children. There was also no marked improvement on child weight or height, as measures of nutritional status, among the intervention group.

These results are in contrast to the assumptions of significant health gains from rural household sanitation interventions. Household sanitation leads to other benefits as convenience, dignity, privacy and safety but health benefits cannot be derived simply by constructing latrines.

“The programme is effective in building latrines but not all households participate. Moreover, many householders do not always use the latrines. This, combined with continued exposure from poor hygiene, contaminated water and unsafe disposal of child faeces may explain  lack of health impact,” Prof Clasen said. While further studies are needed to pinpoint reasons behind low positive health impact, the researchers have suggested some possible explanations including inconsistent use of latrines, lack of proper handwashing practices, good personal hygiene, and even animal faeces. Along with efforts to expand sanitation coverage, approaches need to not only meet coverage-driven targets but also achieve levels of uptake, the researchers have stressed.