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ORIGINAL ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 4  |  Page : 357-361  

Access and utilization of sanitation facilities in a Rural Area of Haryana, North India


1 Professor and Head, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Associate Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Assistant Professor, Department of Public Health, Super Specialty Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
4 Assistant Professor, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
5 Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission21-Aug-2019
Date of Decision29-Oct-2019
Date of Acceptance16-Apr-2020
Date of Web Publication11-Dec-2020

Correspondence Address:
Ravneet Kaur
Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_416_19

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   Abstract 


Background: Ensuring universal access to sanitation in households is essential for public health. Objectives: The objective of the study was to assess the availability of sanitary latrine at the household level and its use at the individual level in a rural area and factors associated with availability and use of sanitary latrine. Methods: This cross-sectional study was conducted from December, 2016 to January 2017 (mention month and year) at the rural Health and Demographic Surveillance Site, Ballabgarh, in district Faridabad, Haryana, North India. A total of 16,896 households were studied. House-to-house visits were made by trained health workers who conducted interviews regarding availability and pattern of use of sanitary latrine in the household. The health worker also observed the type of sanitation facility, its functional status, availability of water, and hand-washing facility. Results: Individual household latrine (IHL) was present in 87.3% of the households. An improved sanitation facility was available in 84.8% of the households, while 15.2% of the households had unimproved or no sanitation facility. Hand-washing facility along with improved sanitation was present in 70.4% of the households. Nonavailability of latrine among socially disadvantaged communities (scheduled caste households) was significantly higher (19.4%) as compared to other castes (10.4%) (P < 0.001). A significantly higher proportion of households below poverty line (28.9%) lacked IHL as compared to those above the poverty line (11.0%) (P < 0.001). Nearly 11% of the individuals reported open defecation. Conclusion: The availability of sanitary latrines in the study area was high. Nonavailability of in-house sanitary latrine was higher among economically poor households and those belonging to socially disadvantaged communities.

Keywords: Access, defecation, latrine, rural, sanitation, utilization


How to cite this article:
Kant S, Kaur R, Lohiya A, Ahamed F, Malhotra S, Haldar P. Access and utilization of sanitation facilities in a Rural Area of Haryana, North India. Indian J Public Health 2020;64:357-61

How to cite this URL:
Kant S, Kaur R, Lohiya A, Ahamed F, Malhotra S, Haldar P. Access and utilization of sanitation facilities in a Rural Area of Haryana, North India. Indian J Public Health [serial online] 2020 [cited 2021 Sep 26];64:357-61. Available from: https://www.ijph.in/text.asp?2020/64/4/357/303098




   Introduction Top


Adequate sanitation is a prerequisite to protect public health. As per the latest estimates (2017), globally, 2.3 billion people still lacked a basic sanitation service, and as many as 892 million people practiced open defecation.[1] Almost 50% of the individuals in rural areas in India went for open defecation in 2016.[2] Globally, sanitation is being reaffirmed by its inclusion in the sustainable development agenda. The Sustainable Development Goals (SDGs) intend to achieve universal access to adequate sanitation by 2030.[3] The Government of India launched the Swachh Bharat Mission in October 2014, wherein cash subsidy was provided for construction of sanitary latrine within the house.[4],[5]

Most of the earlier studies have reported the availability of a sanitary latrine at the household level. However, it has been highlighted that mere availability of an in-house latrine does not ensure its utilization.[6],[7],[8] In the absence of individual-level data, it is not possible to assess if different members of the same family use different facilities for defecation. Thus, the present study was conducted to assess the availability of latrine at the household level and its utilization at the individual level, as well as factors associated with availability and use of sanitary latrine.


   Materials and Methods Top


This was a cross-sectional study conducted at the rural Health and Demographic Surveillance Site (HDSS), Ballabgarh, in district Faridabad, Haryana, North India. HDSS was a network of 28 villages under two primary health centers that had a total population of 97,558 individuals as per the annual census of 2016. There were 16, 869 households in the area and all were included in the study.

Data collection

House-to-house visits were made by trained health workers who administered a self-developed interview schedule to the head of the household or any other responsible adult family member available at that time Data collection was carried out from December 2016 to January 2017. The interview schedule included questions regarding socioeconomic details, availability of sanitary latrine in the household, and the pattern of use of sanitary latrine by various members of the household (in case it was available). In case of nonavailability/nonuse of sanitary latrine, the facility used for defecation was asked.

In addition, the health worker observed the type of sanitation facility available in the household, functional status, availability of water, and hand-washing facility. The facilities were then classified according to the UNICEF/WHO Joint Monitoring Programme (JMP) for Water Supply, Sanitation, and Hygiene[3] as follows:

  1. Improved sanitation facilities: These included flush or pour flush toilets connected to a piped sewer system, septic tank, or pit latrine; ventilated pit latrines; pit latrines with slab; and composting toilets.


  2. The improved facilities were categorized into the following two types:

    1. Basic: Improved sanitation facilities, not shared with other households
    2. Limited sanitation: This includes all improved facilities shared with other households.


  3. Unimproved sanitation/no sanitation: This included pit latrines without a slab, hanging latrines, bucket latrines, and other facilities that flush to locations other than improved pits, septic tanks, or sewer lines.


  4. Safely managed sanitation facilities:


    • An improved sanitation facility, which was not shared with other households
    • Where excreta were either safely disposed in situ or where excreta were treated off-site
    • The presence of a hand-washing facility with soap and water at home.


  5. Hand-washing facility: Facility with running or stored water with the availability of soap for hand-washing at home.


Operational definitions

  • Below poverty line (BPL) households: In this study, the households that possessed BPL card issued by the Government of Haryana were considered as BPL households
  • Scheduled caste households: Households belonging to the scheduled castes as per the data obtained from the Health Management Information System (HMIS) of the HDSS, Ballabgarh. HMIS is a computerized database of all individuals residing in the area and is updated annually.


Training of health workers

The health workers were trained in conducting the interview and classifying various sanitation facilities according to the UNICEF/WHO JMP for Water Supply, Sanitation, and Hygiene.[3] The study investigators imparted 1-day training to 36 health workers who provided routine services in the HDSS villages. For quality assurance, the health workers were supportively supervised by the study team at the time of house visits. Regular review meetings were held with the data collection team.

Data analysis

Data entry was done in Epi-Info version 7.2 (Epi InfoTM Division of Health Informatics & Surveillance (DHIS), Center for Surveillance, Epidemiology & Laboratory Services (CSELS), CDC, Atlanta, USA) and was analyzed using Stata version 12 (Stata Corp LLC 4905, Lakeway Drive College Station, Texas, USA). Categorical variables were expressed as proportions and percentages, and Chi-square test was applied to see the difference between various groups. P < 0.05 was considered statistically significant.

Ethics approval

The study was conducted after obtaining ethical approval from the Institute Ethics Committee of All India Institute of Medical Sciences, New Delhi, vide letter no. IEC-3/09.02.2017, RP-30/2017. All the information collected during the study were kept confidential. No personal identifying information was disclosed.


   Results Top


Of total 16,896 households, data could be collected for 16,516 households. Thus, the response rate was 97.8%.

Nearly one-fourth (24.1%) of the households belonged to scheduled caste families. Majority (91.7%) of the households were above poverty line (APL) [Table 1].
Table 1: Availability and type of sanitation facility by caste and economic status of the household (n=16,516)

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Households having access to a sanitation facility were 14,446 (87.5%). Of the total 16,516 households, 11,295 (68.4%) had flush or pour flush connected to a septic tank and 2715 (16.4%) had pit latrine/ventilated pit latrine with slab. Thus, an improved sanitation facility was available in 14,010 (84.8%) of the households, while 15.2% of the households had unimproved or no sanitation facility. Basic type of facility, i.e., not shared with other households was available in 12618 (76.4%) households, while 1392 (8.4%) had access to the limited type of facility, i.e., latrine shared with other households. The proportion of households having hand-washing facility along with an improved sanitation was 70.4% [Figure 1]. Six percentage of the households had improved sanitary latrine but did not have a hand-washing facility. Nonavailability of Individual household latrine (IHL) among socially disadvantaged communities, i.e., scheduled caste households were higher (19.4%) compared to other caste households (10.4%). This difference was statistically significant (P < 0.001). Similarly, a significantly higher proportion of households BPL (28.9%) lacked IHL as compared to APL households (11.0%) (P < 0.001) [Table 2].
Figure 1: Venn diagram showing various types of sanitation facilities.

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Table 2: Distribution of individuals by age group, sex, and sanitation practices (n=91,201)

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The proportion of scheduled caste households having an improved sanitation facility was 76.9% as compared to 87.3% among other castes. The difference was statistically significant (P < 0.005).

[Table 2] shows individual level characteristics. The study covered a total of 91, 201 individuals, of which 53.1% were males. Among the 81,224 (89.1%) individuals who had access to in-house latrine, 72,228 (79.2%) reported regular use of sanitary latrine. A total of 10,031 (11.0%) individuals reported open defecation. Age-wise and sex-wise distribution of facility used for defecation is shown in [Table 3]. Open defecation was highest (13.5%) among children in the age group of 1–5 years. Sanitary disposal of excreta of infants was reported among half of the individuals. Among adolescents, majority (79.5%) used in-house sanitary latrine, while 81.6% of adults aged 20–59 years and 82.0% of the elderly persons aged = 60 years used sanitary latrine for defecation.
Table 3: Use of sanitation facility according to the age and sex (n=91,201)

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   Discussion Top


In the present study, the availability and use of sanitary latrines in a rural area of Haryana are being reported. Improved sanitation facility was available in 84.8% of the households, while 70.4% of the households had hand-washing facility along with sanitary latrine. In 2015, a nation-wide rapid survey conducted by the Ministry of Statistics and Programme Implementation, Government of India, had reported the availability of in-house sanitary latrine in 90.2% of the households and hand-washing facilities in 88.2% of the households in rural Haryana.[2] In our study, 84.8% of the households reported access to an improved sanitation facility and 76.4% had basic types of facility. It was similar to that reported by the National Family Health Survey (2015–2016) in rural Haryana (77.4%) and was much higher than the national average of 45.3% for rural India.[9]

In the present study, the sanitation facilities have been classified according to the definitions given under the WHO/UNICEF JMP. Few studies in India have used this classification. Bhar et al. used these definitions in a study conducted in a slum area of Siliguri, West Bengal. It was reported that 65.7% of the households had improved sanitation facilities, 3.6% used open defecation, while 27.2% used shared facilities.[10]

We found that a higher proportion of BPL households and those belonging to scheduled caste families did not have an IHL. Many other studies have highlighted similar findings. A study conducted in rural Tamil Nadu, Southern India, by Anuradha et al. reported that the use of sanitary latrine was significantly lower in the study participants belonging to lower socioeconomic status.[11] O'reilly et al. in a study conducted in Uttarakhand reported that the availability of sanitary latrine was low in marginalized communities.[12] Banda et al.'s study conducted in rural Tamil Nadu also reported that access to sanitary latrine was much lower in colony of Harijans (a marginalized community and recognized as scheduled caste by the Government of India), as compared to the main village, a finding similar to our study.[13] Researchers across the globe have suggested that sanitation behaviors need to be studied in depth in the context of social inequalities.[14] This aspect was addressed in a qualitative component of this research, which is being published separately.

Since the launch of Swachh Bharat Abhiyaan (Clean India Mission) in 2014, it has been estimated that coverage of latrines in rural India has increased from 42% to 65% in June 2017.[4] The Mission urged to go beyond mere coverage of latrines and determine the use of sanitation facilities. In this study, availability of sanitary latrine at the household level and its use at the individual level have been reported. In our study, 79.2% of the individuals reported the use of sanitary latrine regularly. Open defecation was reported by 11.0% of the individuals. Among those having an in-house latrine, nearly 3.5% preferred open defecation despite access to sanitary latrine. Effective behavior change communication may be required in such cases.

Our study had few limitations. Behavior regarding the use of latrine by individual household members was ascertained from head of the household or any other responsible adult family member available at that time. This might have led to social desirability bias, and thus, open defecation might have been underreported in this study.

The strengths of our study include coverage of the entire study area with a large sample number of households and direct observation by the trained health worker regarding type and functional status of the facility used for sanitation, as well as the availability of water for handwashing. The study uses the same definitions for classification of sanitation facilities as used by the WHO/UNICEF in the JMP. The JMP provided regular global updates throughout the Millennium Development Goal period and the baseline for SDGs. These categories are useful in monitoring the progress of a specific area over a period of time. At the same time, these can also be used for international comparisons.


   Conclusion Top


The availability of sanitary latrines was high in the study area. Nonavailability of in-house sanitary latrine was higher among BPL households and those belonging to scheduled caste. Effective administrative support may be required to facilitate construction of latrines for such marginalized households. Nearly 11% of the total individuals resorted to open defecation. This highlights the importance of effective behavior change communication, along with construction of sanitary latrines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Licence: CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization (WHO) and the United Nations Children's Fund (UNICEF); 2017.  Back to cited text no. 1
    
2.
National Sample Survey Office. Ministry of Statistics and Programme Implementation, Government of India. Swachhta Status Report; 2016. Available from: http://mospi.nic.in/sites/default/files/publ ication_reports/Swachhta_Status_Report%202016_17apr17.pdf. [Last accessed on 2019 Jul 21].  Back to cited text no. 2
    
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World Health Organization. Integrated Monitoring of Water and Sanitation Related SDG Targets Step-by-Step Monitoring Methodology for Indicator 6. World Health Organization; 2016. Available from: http://www.who.int/water_sanitation_he alth/monitoring/coverage/step bystep-631-20161021.pdf. [Last accessed on 2019 May 15].  Back to cited text no. 3
    
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Swachhbharat Mission – Guidelines. Available from: http://www.indiaenvironmentportal.org.in/./guide lines_Swachh_Bharat_Mission_Gramin. [Last accessed on 2019 Mar 20].  Back to cited text no. 4
    
5.
Ministry of Drinking Water and Sanitation. Swachhbharat Mission – Gramin. Available from: http://tsc.gov.in/TSC/NBA. [Last accessed on 2019 Mar 25].  Back to cited text no. 5
    
6.
Lakshmi R. India is Building millions of Toilets, but that's the Easy Part. The Washington Post; 2015. Available from: https://www.washingtonpost.com/world/asia_pa cific/india-is-building-millions-of-toilets-but-toilet-traini. [Last accessed on 2019 May 28].  Back to cited text no. 6
    
7.
Pandey K. Despite having Toilets at Home, Many in Rural India Choose to Defecate in Open. Down to Earth; 2015. Available from: https://www.downtoearth.org.in/news/despite-having-toilets-at-home-many-in-rural-in dia-choose-to-defecate-in-open-44916. [Last accessed on 2019 Jul 15].  Back to cited text no. 7
    
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Moudgil M. Haryana Gets Toilets, Now to Focus on Usage. India Water Portal. Available from: https://www.indiawaterportal.org/articles. [Last accessed on 2019 May 24].  Back to cited text no. 8
    
9.
National Family Health Survey (NFHS-4): India Fact Sheet; 2015. Available from: http://www.rchiips.org/nfhs. [Last accessed on 2019 Mar 19].  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
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Anuradha R, Dutta R, Raja JD, Lawrence D, Timsi J, Sivaprakasam P. Role of community in Swachhbharat mission: Their knowledge, attitude and practices of sanitary latrine usage in rural areas, Tamil Nadu. Indian J Community Med 2017;42:107-10.  Back to cited text no. 11
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O'Reilly K, Dhanju R, Goel A. Exploring the remote and the rural: Open defecation and latrine use in Uttarakhand, India. World Dev 2017;93:193-205.  Back to cited text no. 12
    
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Banda K, Sarkar R, Gopal S, Govindarajan J, Harijan BB, Jeyakumar MB, et al. Water handling, sanitation and defecation practices in rural Southern India: A knowledge, attitudes and practices study. Trans R Soc Trop Med Hyg 2007;101:1124-30.  Back to cited text no. 13
    
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O'Reilly K, Louis E. The toilet tripod: Understanding successful sanitation in rural India. Health Place 2014;29:43-51.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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