Sanitation drive ineffective in improving health in rural India: Lancet

Total Sanitation Campaign - the world's largest sanitation initiative in India - provided almost 25,000 individuals in 100 rural villages in Odisha access to toilets but it did not reduce exposure to faecal pathogens or decrease the occurrence of diarrhoea or child malnutrition, says a study.

Moreover, many householders do not always use the latrines, added the study funded by Bill and Melinda Gates Foundation and reported by the prestigious journal The Lancet.

"This, combined with continued exposure from poor hygiene, contaminated water, and unsafe disposal of child faeces may explain the lack of a health impact. The programme is effective in building latrines but not all households participate," explained lead study author professor Thomas Clasen from Emory University in Atlanta and London School of Hygiene and Tropical Medicine in Britain.

The cluster-randomised trial involved 9,480 households with a child younger than four years or a pregnant woman.

Households in 50 villages were randomly assigned to receive the sanitation intervention in early 2011 while control villages received the intervention after a 14-month surveillance period.

The intervention increased the average proportion of households in a village with a latrine from 9 percent to 63 percent compared to an increase of 8 percent to 12 percent in control villages.

However, researchers found no evidence that the intervention protected against diarrhoea in children younger than five years.

Seven-day prevalence of reported diarrhoea was 8.8 percent in the intervention group (1,919 children) and 9.1 percent in the control group (1,916 children).

"What is more, the intervention did not reduce the prevalence of parasitic worms that are transmitted via soil and can cause reduced physical growth and impaired cognitive function in children. There was also no impact on child weight or height - measures of nutritional status," the authors wrote.

Worldwide, around 2.5 billion people lack access to basic sanitation facilities such as a latrine, a third of whom live in India.

Two-thirds of the 1.1 billion people who practice open defecation and a quarter of the 1.5 million who die every year from diarrhoeal diseases are caused by poor hygiene and sanitation also live in India.

Inconsistent use of latrines and lack of handwashing with soap or animal faeces could also be contributing to the disease burden, researchers noted.

Total Sanitation Campaign (TSC), a community-led total sanitation programme initiated by the government of India in 1999, was later rechristened as Nirmal Bharat Abhiyan (NBA).

A demand-driven and people-centered sanitation programme, its main goal is to eradicate the practice of open defecation by 2017.