Measuring open defecation in India using survey questions: evidence from a randomised survey experiment

Abstract

ObjectivesTo investigate differences in reported open defecation between a question about latrine use or open defecation for every household member and a household-level question.SettingRural India is home to most of the world’s open defecation. India’s Demographic and Health Survey (DHS) 2015–2016 estimates that 54% of households in rural India defecate in the open. This measure is based on a question asking about the behaviour of all household members in one question. Yet, studies in rural India find substantial open defecation among individuals living in households with latrines, suggesting that household-level questions underestimate true open defecation.ParticipantsIn 2018, we randomly assigned latrine-owning households in rural parts of four Indian states to receive one of two survey modules measuring sanitation behaviour. 1215 households were asked about latrine use or open defecation individually for every household member. 1216 households were asked the household-level question used in India’s DHS: what type of facility do members of the household usually use?ResultsWe compare reported open defecation between households asked the individual-level questions and those asked the household-level question. Using two methods for comparing open defecation by question type, the individual-level question found 20–21 (95% CI 16 to 25 for both estimates) percentage points more open defecation than the household-level question, among all households, and 28–29 (95% CI 22 to 35 for both estimates) percentage points more open defecation among households that received assistance to construct their latrines.ConclusionsWe provide the first evidence that individual-level questions find more open defecation than household-level questions. Because reducing open defecation in India is essential to meeting the Sustainable Development Goals, and exposure to open defecation has consequences for child mortality and development, it is essential to accurately monitor its progress.Trial registration numberRegistry for International Development Impact Evaluations (5b55458ca54d1).

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

“…In this analysis, we gained insight into toilet usage by asking if anyone in the household regularly used the bush or field to defecate at work or at home. Our finding was consistent with prior evidence that household-level sanitation questions underestimate the amount of OD 35. During the first round of the survey 27.2% of all households with toilets stated that at least one household member was still openly defecating outside of the home.…”

Open defecation and squat toilets, an overlooked risk of fecal transmission of COVID-19 and other pathogens in developing communities

“…Table 1 lists the key data and findings from recent randomized surveys on the prevalence of open defecation in developing countries. Echoing with two previous studies (Bhatt et al 2019 ; Vyas et al 2019 ), the surveys suggested that the real situation of open defecation is likely to be underreported in those countries. Despite an increasing number of toilets and latrines, several factors have hindered efforts in eliminating this unhygienic practice, while population growth aggravated this problem (WHO 2019 ).…”

“… At least 20 developing countries reported a significant portion of their population practicing open defecation (> 5%) WHO ( 2017b ) Worldwide Data statistics n.a. Progress of eliminating open defecation in 37 developing countries before the year 2030 is quite slow UNICEF ( 2018 ) Tanzania Data analysis Nationwide Despite the overall declined prevalence, open defecation is common in the Northeastern and lake regions in Tanzania Maliti ( 2020 ) India Random survey 1216 households The real situation of open defecation in India is underestimated Vyas et al ( 2019 ) India Interviews 21 individuals People have been aware of the risks associated with open defecation. However, challenges remain in constructing more latrines in rural areas Jain et al ( 2020 ) Ethiopia Questionnaire 758 households The magnitude of diarrheal diseases in under-five children is approximately twofold in communities practicing open defecation compared to those with no open defecation Tafere et al ( 2020 ) Ghana Questionnaire 367 households A multitude of factors including education, household size, occupation, income, traditional norms, beliefs, and ownership of a toilet facility have impacts on the choice of open defecation Osumanu et al ( 2020 ) Kenya Questionnaire 403 individuals The practice of open defecation is associated with the design, structure, and conditions of latrines.…”

The use of behavioural-science informed interventions to promote latrine use in rural India: a synthesis of findings

“…The higher rate of latrine use among women may be initially viewed as positive, reflecting value of women's dignity and safety and indicating social inclusion. However, millions of women in rural India use the time they spend walking to the fields to be away from their in-laws, household chores, and other daily burdens and socialize with their friends or other women in the village (Routray et al, 2015;Vyas et al, 2019). While the reduction in open defecation is important, efforts must be made to avoid the reduction in women's freedom of movement that may accompany it.…”

“…This results in latrines with full pits being abandoned rather than emptied (Coffey et al, 2017). In order to maintain low rates of open defecation, interventions will need to target the combined and interacting barriers of caste and fear of latrine pits filling in India (Lahiri et al, 2017;Routray et al, 2015;Vyas et al, 2019). Efforts should also be made to protect the dignity of dalits, who have traditionally been employed in pit emptying (Coffey et al, 2017;Ray, 2019, 2018).…”