A cluster-randomized multi-level intervention to increase latrine use and safe disposal of child feces in rural Odisha, India: the Sundara Grama research protocol

Caruso, Bethany A.; Sclar, Gloria D.; Routray, Parimita; Majorin, Fiona; Nagel, Corey; Clasen, Thomas

doi:10.1186/s12889-019-6601-z

Cited by 20 publications

(46 citation statements)

References 21 publications

(18 reference statements)

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“…New insight is provided by our finding that for households with limited communal toilet sharing (less than 10 households) there was a reduced odds that a household member would openly defecate when compared with households that do not share their toilet. In the post-SBM era it is important to understand the reasons for continued OD despite the construction of toilets,40 both within the household context and in communal environments such as workplaces and public markets.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

et al. 2020

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BackgroundThe most ambitious sanitation campaign to end open defecation (OD) in India came to a close on 2 October 2019 and there are limited independent, robust data to measure its success. We aimed to evaluate Rajasthan’s claim of open defecation free status in March 2018 under the Swachh Bharat Mission (SBM) or ‘Clean India Mission’ by measuring OD trends from 2016 to 2018.MethodsWe used publicly available data from Performance Monitoring and Accountability 2020, a representative survey with two-stage stratified cluster sampling. Enumeration areas were the primary sampling units selected by the probability proportional to size method. The repeated cross-sectional surveys independently collected household water and sanitation data in Rajasthan (n=20 485). Among households reporting toilet access, the data were pooled across the four rounds for an observational analysis using logistic regression. The primary outcome measure was regular OD among households with access to toilet facilities.FindingsBetween October 2016 and July 2018 main OD practices in rural Rajasthan households decreased from 63.3% (95% CI 57.0% to 69.6%) to 45.8% (95% CI 38.4% to 53.2%) and in urban households from 12.6% (95% CI 6.0% to 19.1%) to 9.4% (95% CI 4.0% to 14.7%). Households with regular OD occurring despite access to a toilet made up 21.7% (95% CI 16.9% to 26.6%) of rural and 12.1% (95% CI 3.6% to 20.7%) of urban Rajasthan as of July 2018. The multivariate logistic regression revealed that factors related to water stress and sanitation sharing were associated with household members regularly practising OD.ConclusionsThese data highlight the importance of a continued focus on constructing toilets that are affordable with low water requirements during the next phase of SBM. An independent survey that can provide robust estimates of OD is needed to monitor progress of toilet construction and use.

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Section: Discussionmentioning

confidence: 99%

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

et al. 2020

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“…Four studies evaluated sanitation hardware and behaviour change interventions, which included the provision of child sanitation hardware (potties and sani‐scoops) and behaviour messaging (Caruso 2019 IND; Christensen 2015a KEN; Luby 2018 BGD; Null 2018 KEN). Three of these trials were from WASH Benefits (WASH B) study, one from the pilot in Kenya (Christensen 2015a KEN), and on the main outcomes from Kenya (Null 2018 KEN) and Bangladesh (Luby 2018 BGD).…”

Section: Resultsmentioning

confidence: 99%

“…Stanton 1987 BGD was conducted in urban Bangladesh; Barrios 2008 PHI in rural Philippines; Cameron 2013 INA in rural Indonesia; Caruso 2019 IND, Dickinson 2015 IND, Nair 2017 IND, and Patil 2014 IND in rural India; and Luby 2018 BGD in rural Bangladesh. Altmann 2018 TCD was conducted in Chad, Briceño 2015 TAN in rural Tanzania, Christensen 2015a KEN and Null 2018 KEN in rural Kenya, Haggerty 1994 DRC in rural Democratic Republic of Congo (DRC), Hashi 2017 ETH in rural Ethiopia, Jinadu 2007 NGR in rural Nigeria, Pickering 2015 MLI in rural Mali, Sarrassat 2018 BUR in rural Burkina Faso, Sinharoy 2017 RWA in rural Rwanda, and Humphrey 2019 ZIM in rural Zimbabwe.…”

Section: Resultsmentioning

confidence: 99%

“…Caruso 2019 IND evaluated a multilevel behaviour change intervention the "Sundara Grama", which aimed to increase latrine use and safe disposal of child faeces. The intervention included activities at the community level (a traditional folk dance, a transect walk, community meeting, recognition of positive deviants, village map painting), group level (mother's group meeting), and household level (household visits and latrine repairs).…”

Section: Resultsmentioning

confidence: 99%

“…Barrios 2008 PHI and Christensen 2015a KEN were at high risk for incomplete outcome data, five RCTs were at unclear risk (Butz 1990 USA; Caruso 2019 IND; Jinadu 2007 NGR; Stanton 1987 BGD; Yeager 2002 PER), and the remaining 15 at low risk.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Majorin

Torondel

Chan

et al. 2019

Cochrane Database of Systematic Reviews

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BackgroundDiarrhoea and soil‐transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low‐income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation.ObjectivesTo assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018.Selection criteriaWe included randomized controlled trials (RCTs) and non‐randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults.Data collection and analysisTwo review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta‐analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach.Main resultsSixty‐three studies covering more than 222,800 participants met the inclusion criteria. Twenty‐two studies were cluster RCTs, four were controlled before‐and‐after studies (CBA), and 37 were NRS (27 case‐control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross‐sectional studies). Most study sites (56/69) were in low‐ or lower middle‐income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low‐certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low‐certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low‐certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoe...

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Mixed Methods Process Evaluation of a Sanitation Behavior Change Intervention in Rural Odisha, India

Sclar

Routray²,

Majorin

et al. 2022

Glob Implement Res Appl

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Background Process evaluations of public health programs are critical to understand if programs were delivered as intended and to identify improvements for future implementations. Here we present a mixed methods process evaluation of the Sundara Grama intervention, which sought to improve latrine use and safe child feces disposal among latrine-owning households in rural Odisha, India. Methods The Sundara Grama intervention was delivered to 36 villages in Puri district by a grassroots non-governmental organization (NGO) and included eight activities: palla performance, transect walk, community meeting, community wall painting, mother’s meeting, positive deviant household recognition, household visit, and latrine repairs. The process evaluation quantitatively assessed fidelity, dose delivered, and reach, and qualitatively examined recruitment, context, and satisfaction. Quantitative data collection included an activity observation survey, activity record, and endline trial survey. Qualitative data collection included an activity observation debrief and in-depth interviews with NGO mobilizers. For the quantitative data, a ‘delivery score’ was calculated for each activity, as well as the proportion of target participants in attendance. Qualitative data were analyzed using thematic analysis. Results Mean delivery scores, reported as a percentage, were moderate to high. Household visit activities (97% general visit, 96% positive deviant visit) and the mother’s meeting (81%) had the highest delivery scores, followed by the palla (77%), transect walk (77%), and community meeting (60%). Activities were attended, on average, by 30% to 73% of latrine-owning households. Several factors aided delivery, including pre-intervention rapport building visits and village stakeholder support. Factors that hindered delivery included inclement weather, certain recruitment strategies, and village social dynamics. Conclusions Overall, the Sundara Grama intervention was implemented as intended and achieved good reach. The findings suggest education-entertainment strategies, like the palla, and multi-level communication approaches are particularly beneficial. The results also showcase the importance of examining the implementer experience and broader context.

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A cluster-randomized multi-level intervention to increase latrine use and safe disposal of child feces in rural Odisha, India: the Sundara Grama research protocol

Cited by 20 publications

References 21 publications

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection

Mixed Methods Process Evaluation of a Sanitation Behavior Change Intervention in Rural Odisha, India

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