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ORIGINAL ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 4  |  Page : 248-253  

Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal


1 Senior Resident, Department of Community and Family Medicine, All Institute of Medical Sciences, Patna, Bihar, India
2 Assistant Professor, Department of Community Medicine, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
3 Demonstrator, Department of Community Medicine, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
4 Professor, Department of Community Medicine, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India

Date of Web Publication6-Dec-2017

Correspondence Address:
Sharmistha Bhattacherjee
Department of Community Medicine, North Bengal Medical College, Sushrutanagar, Darjeeling - 734 012, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_345_16

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   Abstract 


Background: With the rapid expansion of urban population, provision of safe water and basic sanitation is becoming a challenge; especially in slums. This is adversely affecting the health of the people living in such areas. Objectives: The study was conducted to measure the proportion of households using improved drinking water and sanitation facilities and to determine the association between diarrhea in under-five children with water and sanitation facilities. Methods: A community-based, cross-sectional study was conducted among 796 slum households in Siliguri from January to March 2016 by interviewing one member from each household using a predesigned and pretested questionnaire based on the WHO/UNICEF Joint Monitoring Program Core questions on drinking water and sanitation for household surveys. Results: A majority 733 (92.1%) of slum households used an improved drinking water source; 565 (71%) used public tap. About two-thirds (65.7%) household used improved sanitation facilities. About 15.8% households had reported diarrheal events in children in the previous month. Unimproved drinking water sources (AOR = 4.13; 1.91, 8.96), houses without piped water supply (AOR = 4.43; 1.31, 15.00), and latrines located outside houses (AOR = 3.61; 1.44, 9.07) were significantly associated with the diarrheal events in children. Conclusion: The utilization of improved drinking water source was high but piped water connection and improved sanitary toilet used was low. Association between diarrheal events and type of drinking water sources and place of sanitation might suggest fecal contamination of water sources. Awareness generation through family-centered educational programs could improve the situation.

Keywords: Children, diarrhea, improved drinking water, improved sanitation, slum


How to cite this article:
Bhar D, Bhattacherjee S, Mukherjee A, Sarkar TK, Dasgupta S. Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal. Indian J Public Health 2017;61:248-53

How to cite this URL:
Bhar D, Bhattacherjee S, Mukherjee A, Sarkar TK, Dasgupta S. Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal. Indian J Public Health [serial online] 2017 [cited 2019 Dec 7];61:248-53. Available from: http://www.ijph.in/text.asp?2017/61/4/248/220064




   Introduction Top


Sanitation is the science of safeguarding health. Due to lack of safe and adequate drinking water and basic sanitation many illnesses, including diarrhea, have affected civilizations since ancient centuries; especially in the developing countries. Although the target of Millennium Development Goals (MDG) to halve the proportion of people without sustainable access to safe drinking water was met, the target for sanitation is yet to be achieved. Moreover, mere access does not provide assurance of their efficient utilization. In 2015, it was estimated that globally 663 million people still use unsafe drinking water sources and 2.4 billion people lack improved sanitation facilities.[1]

Despite comprehensive programs such as the total sanitation campaign, open defecation still remains common. The untreated and improper disposal of sewage contaminates the rivers, ponds, and groundwater supplies. People exposed to contaminated water sources often suffer from enteric infections such as diarrhea. It is estimated that unsafe water and a lack of basic sanitation claim the lives of >1.2 million under-five children every year due to diarrhea.[2]

The rapid increase in the slum population due to urbanization and industrialization compel the dwellers to live in unhygienic overcrowded conditions with inadequate drinking water and sanitation facilities. As per Census 2011, 17.4% of urban households in India live in slums, West Bengal, accounting for about 12% of all slums in India.[3],[4] According to the National Family Health survey 4, (space) 93.5% urban households in West Bengal have an improved drinking water source and 62.0% use improved sanitation facilities.[5] These figures represent an average statistics over the state masking the regional differences among different parts of the state.

Siliguri, the second largest city in West Bengal is situated in the northern part of West Bengal. The city has 47 wards and 154 slums, and almost one-third of the inhabitants reside in slums.[6] In Siliguri, the source of drinking water is mainly surface water. The city has no modern sewerage system.

This study was conducted to measure the proportion of slum households using improved drinking water and sanitation facilities and to determine the association between diarrhea in under-five children with the water and sanitation facilities.


   Materials and Methods Top


Study type and setting

The community-based, descriptive, cross-sectional study was conducted in the slum households of Siliguri Municipal Corporation (SMC) during a 3-month period from January to March 2016.

Study population

The study population were all households in the slums for which consent could be obtained from the head of the household.

Sampling

The sample size was calculated using the formula [7] Zα2P (1-P)/d 2, taking proportion of improved sanitation facilities in urban households in West Bengal,[5] as 62.0%, 95% level of confidence, 5% absolute precision and design effect of 2. Considering 10% nonresponse rate, total sample size finally became 804. Cluster sampling technique was applied to select 30 slums out of 154 according to probability proportion to size. Considering each slum as a cluster, from each of the identified slums, 27 households were selected randomly.

Data collection tools and techniques

A predesigned, pretested questionnaire based on the WHO/UNICEF Joint Monitoring Program core questions on drinking water and sanitation for household surveys was the data collection tool.[8] Drinking water sources were defined as “improved” and “not improved” based on definitions used by the WHO. Improved sources included a piped water supply into the dwelling, piped water to a yard/plot, a public tap/standpipe, a tube well/borehole, and a protected dug well. Sanitary facility was considered “improved” if it hygienically separated excreta from human contact like flush to piped sewer system, flush to septic tank, flush/pour flush to pit, composting toilet, ventilated improved pit latrine, and pit latrine with a slab.[8] Diarrhea was defined as three or more loose or watery stools in 24-h period.

The district and municipal health authorities of Siliguri subdivision were informed about the study. The health supervisors of the respective 30 slums were contacted and were trained on data collection. Quality of the data collection was assured by making frequent visit to the slums on the day of data collection and by checking of the completeness and correctness of the questionnaire. One adult member of each household who is usually engaged in water collection was interviewed. Households that could not be accessed for interview after two visits were considered as nonresponders. Data from each household were recorded about the main water source for drinking, cooking and hand washing, time of water collection on a single occasion, person collecting water, methods of water disinfection, type of sanitation facilities used by the households, use of shared toilet, and disposal of young children's feces. Each household respondent was asked about diarrheal events in the past 1 month among the youngest child.

Data analysis

Data were checked and analyzed by IBM SPSS (Version 20; SPSS Inc., Chicago). The proportion of improved and unimproved drinking and cooking water sources and sanitation facilities were calculated. Binary logistic regression was applied to find out the water and sanitation related factors associated with diarrhea in under-five children, the dependent variable being the presence of at least one event of diarrhea in the previous 1 month; denoted as 1 and absence of diarrhea as 0. Crude odds ratio (OR) and confidence interval (CI) were measured for the identified variables. Significant independent variables at univariate analysis were included in the multivariable model for avoiding confounding. Step-wise logistic regression was done and the adjusted OR was calculated to identify the associated factors. The fit of the final model was assessed using Hosmer–Lemeshow goodness-of-fit test.

Ethical considerations

This study was approved by the Institutional Ethics Committee of North Bengal Medical College. The study participants were explained about the purpose of the study and informed consent was taken.


   Results Top


Out of a total of 804 households, members from 796 responded. Six households could not be included in the study because of unavailability of any adult member and two houses were found locked during data collection.

This study revealed 14.2% of the households were headed by females. About 48.5% of the study participants were unskilled, 25.3% businessman, 22% skilled worker, 3.8% semi-skilled and 0.4% were semi-professional. Most of the study participants (47.2%) belonged to the lower-middle socio-economic class according to the modified B. G Prasad scale, 44.7% in lower class, 7.4% middle class, and only one of five participants in upper and upper-middle class, respectively. Among the study households, 386 (48.5%) had under-five children, of which 126 (32.6%) households had reported at least one episode of diarrhea in the previous month.

This study revealed 733 (92.1%) of the slum households used improved drinking water source; public tap (71%) being the primary source. Less than a tenth (9.9%) of the households had piped drinking water supply inside the house premises, 8.4% used tube-well, 2.8% protected dug well, and 2.4% used to store water in small drum from the cart [Table 1].
Table 1: Drinking and cooking and/or hand washing water sources in the slum households (n=796)

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This study showed 54.9% of households used improved, whereas 45.1% of used unimproved water sources for cooking and/or hand washing purpose. Most of the households (41.2%) used unprotected dug well and 3.9% used water from surface water of river, ponds, 20.9% from tube well, 14.9% from public tap, 12.4% from protected dug well, and 6.7% from piped water sources in the house premises [Table 1].

A major percentage of the adult women (85.4%) spent 20 min on one trip for water collection daily. About 10.7% of the households who did not have water sources inside the house premises had to spend > 30 min daily for water collection. A considerable proportion of households, 651 (81.8%) did not use any method for disinfecting drinking water. Among the households using some method of water disinfection, 35.9% used boiling, 19.3% used to strain water with cloths, 17.2% had water filters, 15.2% used to add chlorine tablets, 10.3% used to keep water-filled bottles and buckets under sun (solar disinfection [SODIS]), while 13.1% allowed water to stand and settle.

Almost two-third of the households (65.7%) used improved sanitation facilities, of which 47.5% had flush/pour flush facility and 18.2% used improved pit latrine. More than a third household (34.3%) used unimproved sanitation facilities; 27.2% used shared latrines, 2.6% used pit latrine without slabs, 3.6% used open field, and 0.9% used hanging toilets [Table 2]. About 20.4% of the households did not have latrine inside house-premises; 16.8% among them stated using community latrines. About 64% of the households disposed children's feces into latrine, 21.5% into drains, 10.6% into garbage or open field, and 3.9% used to bury the feces with soil [Table 2].
Table 2: Sanitation facilities in the slum households according to toilet facilities

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[Table 3] depicts the relationship of the sociodemographic characteristics of the households and the use of drinking water and sanitation facilities. The occupation of the head of the family was found to be significantly associated with the drinking facility types and socioeconomic status was found to be significantly related to the sanitation facility used by the households.
Table 3: Relationship of water and sanitation facilities according to sociodemographic profile of the slum households

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On univariate logistic regression between diarrhoea in under-five children and water and sanitation facilities of slum households, the improved sources of drinking water (OR-6.18; 95% CI-3.03, 12.59) and cooking water (OR = 2.27; 95% CI = 1.48, 3.51), households without piped water supply within the house premises (OR = 5.96; 1.79, 19.83) and latrine facilities outside houses (OR = 2.14; 1.28, 3.56) were found to be statistically significant. The other factors considered in the model, water sources within the house (including both improved and unimproved), use of any water disinfection method, latrine type used by the household members, and type of sanitation facility used to dispose children's feces were found not significant [Table 4].
Table 4: Binary logistic regressions showing factors associated with diarrhea in under-five children and water and sanitation facilities of slum households

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On multivariable analysis, unimproved drinking sources (AOR = 4.13; 1.91, 8.96), houses without piped water supply (AOR = 4.43; 1.31, 15.00), and latrines located outside houses (AOR = 3.61; 1.44, 9.07) were statistically significant [Table 4]. After controlling for the water and sanitation factors, the model predicted between 11.4% (Cox and Snell Rsquare) and 15.8% (Nagelkerke Rsquare) of the variance of diarrhea, and 71.8% of the diarrea events in study children. The contribution of the independent variables was significant and the model fitness was good as the Hosmer–Lemeshow test was not significant (P = 0.987).


   Discussion Top


Safe wholesome water and basic sanitation facilities are human rights. With the rapid increase in urban population, provision of accessible, affordable and acceptable safe drinking water and sanitation facility in urban slums, and bridging the utilization gap between slums and nonslums is a challenge.

The present study found a diverse pattern of water consumption and sanitation practices in the slums of Siliguri. Although the proportion of households with improved drinking water was comparable with global achievements,[1],[9],[10] the proportion of piped household water connection was lesser than the national averages (56.7%).[3],[10],[11] Evidence from other middle and lower socioeconomic countries like Myanmar [12] and Vietnam [13] showed a higher proportion of household in the slums with piped water supply. Such households with piped water connections have been seen to utilize more water for cooking and hygienic purposes.[14],[15] Households members who do not have to travel to collect water have more time for child care, personal hygiene maintenance and can participate in productive economic activities.[15],[16]

Nonavailability of sufficient quantity of clean water in households necessitates the augmentation of its needs with water from some other contaminated and unsafe sources. This practice negatively affects the health of people, which is reflected by the increased burden of waterborne diseases, especially among under-five children.[13] A multicentric study convened by the WHO and a similar study in Myanmar reported that approximately 88% of diarrheal diseases are attributable to unsafe drinking water.[10],[12] Several meta-analyses had proven that households with piped water connection experienced less diarrhea than households without a piped water connection.[13],[17],[18] This reiterates the requirement of greater piped household connection in the slums.

In India, as in other countries around the world, traditionally, women are tasked to collect water for the household.[2],[9],[16],[19],[20] In 2012, in a study among 25 countries, it was estimated that women spend a combined total of at least 16 million hours each day collecting drinking water and have to travel quite far from their houses, sometimes during the night.[21] In East Africa, women often have to travel four times during a day to collect water. Women from unpiped households in urban areas of East Africa have to walk for 37.2 min per trip on an average to collect water.[16] In Sub-Saharan Africa, a study in 26 countries found that a 15 min decrease in one-way walk time is significantly associated with a 41% average relative reduction in diarrhea prevalence in under-five children.[22] In the current study, although a majority of the slum households had an accessible water source,[15] a high proportion of women had to walk for >30 min to collect the same due to very few piped water connections in the slums. Sometimes, to avoid such long walks, women decide to collect water from nearby “nonimproved” sources, thus compromising the quality of water.

In a survey of 45 developing countries in Eastern and Southern Africa, it was reported that in 12% of households where children collect water, girls were involved twice as often as compared to boys. They often have to walk long distances to fetch water, early in the morning, leading to poor school attendance, and dropout.[19],[20] In our study, a very small proportion of young girls had the responsibility of collecting water, probably because of an increased awareness of the community toward the rights of the girl child.

Chlorination and candle filtration are often regarded as the most cost-effective water disinfection methods at the household level that can improve the water quality.[23] Poor utilization of water disinfection methods by the dwellers in the present study could be related with their lack of knowledge and awareness about proper purification methods at the household level. In this context, the slums of Delhi appeared to be superior in that they showed 15% of households used filters and 10% used water after boiling,[24] Global evidence show that in poor household settings SODIS (Solar Disinfection) can be one of the best methods of water purification if done properly. This easy and affordable method has shown to reduce diarrheal diseases in under-five children.[25],[26],[27],[28],[29],[30],[31] Efforts directed toward enhancing the knowledge and awareness among the slum dwellers in the study area can lead to a change in their current behavior about water disinfection.

MDG target has fallen short of providing basic sanitation. Globally, 2.4 billion people still lack improved sanitation facilities.[1] In Ethiopia, most people in urban slums (88.6%) used unimproved sanitation facilities, pit latrines being the mostly used toilet type.[32] In low-middle income countries, almost 58% of people use an improved nonshared household sanitation facility.[10] The proportion of household members using nonsanitary toilets in the study area are similar to the global levels but lesser than those reported from slums in other parts of India.[9],[21],[24] Even among households with latrine facilities, majority lacked piped water connection, and diarrhea was found to be significantly higher in these households. Open defecation, although seen in members of some households, was much lower as compared to other areas.[15],[16],[21],[32] Various organizations have started different approaches, including CLTS (Community-Led Total Sanitation) and SLTS (School-Led Total Sanitation), to stop open defecation throughout the world including India.[33] In recent times, to achieve the MDG target, the government and local bodies have set up shared latrines for communities. However, these are not regarded as improved as there is high possibility of lack of hygiene. Evidence showed that improvement in latrine facilities and individual latrine at homes can effectively prevent diarrhea.[10],[15],[17],[18],[33]


   Conclusions Top


Although utilization of drinking water in Siliguri slums has increased towards globally comparable levels, household connections of piped water supply are still lacking and many people do not have access to basic sanitary services. Association between diarrhea and water and sanitation facilities might suggest fecal contamination of water sources. Shifting from unimproved water sources to improved sources by providing piped connection to houses will help in health gains by declining probable water contamination. Increasing access to basic sanitation at the household level remains important but ignored public health intervention for preventing diarrhea. The local administration needs to accelerate action on providing safe water and basic sanitation to those currently unserved. The provision of advanced levels of service, which protect whole communities from fecal exposure, might provide significant additional protection from diarrhea.

Acknowledgments

The authors gratefully acknowledge the contributions of the female health supervisors and health workers working in the slums for their cooperation during data collection. We especially thank the study participants who welcomed us into their communities and homes and responded effectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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