Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana

Babita Rani; Anshu Yadav; Sanjay Kumar Jha; Anita Punia; Sanjeet Singh

doi:10.4103/ed.ed_22_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 5 | Issue : 4 | Page : 87-92

Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana

Babita Rani, Anshu Yadav, Sanjay Kumar Jha, Anita Punia, Sanjeet Singh
Department of Community Medicine, BPS GMC for Women, Sonepat, Haryana, India

Date of Submission	25-Jul-2020
Date of Decision	27-Aug-2020
Date of Acceptance	12-Oct-2020
Date of Web Publication	31-Dec-2020

Correspondence Address:
Dr. Anita Punia
Department of Community Medicine, BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ed.ed_22_20

Abstract

Context: Constructing latrines and getting people to use them is one of the most effective means of improving public health and saving lives. However, building toilets alone cannot eliminate open defecation.
Aims: The aim was to estimate the prevalence of open defecation and factors associated with open defecation in rural areas of a district of Haryana.
Settings and Design: This community-based cross-sectional study was carried out in a rural field practice area attached to the department of community medicine of a rural medical college.
Subjects and Methods: The study was carried out from July to October 2019. The data were collected from 368 randomly selected households on a pretested semi-structured proforma. Ethical approval was obtained from the institutional ethics committee.
Statistical Analysis Used: The data were analyzed using the software R, version 3.6.2. Chi-square, Fisher's exact test, crude odds ratio, adjusted odds ratio with 95% confidence interval, and P value were calculated.
Results: The prevalence of open defecation was 30.97% despite having a household toilet. Among the study participants practicing open defecation, the prevalence of open defecation was significantly higher among scheduled caste (64.9%), illiterates (42.7%), laborers (56.6%), and low family income (41.5%). The participants who have constructed latrine recently, i.e., <1 year before (87%), latrine constructed by government expenses (76.9%), and rarely cleaning of the latrine (76.5%) also contributed significantly. Multivariate logistic regression analysis showed that four of these predictor variables, caste, occupation of the head of the family, years since latrine constructed, and latrine cleaning remained significant predictors of open field defecation.
Conclusions: Open defecation is common among latrines owners. This behavior is associated with various several structural and sociocultural factors. The present sanitation campaign should consider shifting from toilet construction to toilet use.

Keywords: Open defecation, prevalence, sanitation, toilet

How to cite this article:
Rani B, Yadav A, Jha SK, Punia A, Singh S. Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana. Environ Dis 2020;5:87-92

How to cite this URL:
Rani B, Yadav A, Jha SK, Punia A, Singh S. Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana. Environ Dis [serial online] 2020 [cited 2023 Mar 26];5:87-92. Available from: http://www.environmentmed.org/text.asp?2020/5/4/87/305709

Introduction

Adequate sanitation, good hygiene, and safe water are fundamental to good health and social and economic development.^[1] Improving water, sanitation, and hygiene has the potential to prevent at least 9.1% of the disability-adjusted life years or 6.1% of all deaths globally.^[2],[3] Around one billion people practice open defecation worldwide, of which 597 million live in India.^[4] A study from five northern states of India reported that 40% of households with a working toilet have at least one member who defecates in the open.^[5] In India, the use of latrines is low despite health, economic, and social benefits of sanitation.^[6] This study was done to estimate the prevalence of open defecation and factors associated with open defecation in households with toilet in rural areas of Haryana.

Subjects and Methods

Study design

This community-based cross-sectional study was carried out in a rural field practice area attached to the department of community medicine in a rural medical college in North India from July to October 2019.

Inclusion criteria

Households having toilet in their house during the survey were included in the study.

Exclusion criteria

Locked households
Nonavailability of adult members during the survey.

Sample size

Taking open defecation of 40% among adults with toilet^[5] 5% absolute precision, and a 95% confidence level, the calculated sample size was 368 households with toilet.

Sampling technique

Two subcenters were chosen randomly from the primary health center of the rural field practice area attached to the department of community medicine. Equal numbers of houses from the respective subcenters were chosen by simple random sampling. One adult member from each selected household was taken randomly.

Data collection

The data were collected on a semi-structured proforma having information on sociodemographic profile, use of sanitary latrine, usual defecation place, source of water supply, drainage facilities, latrine being used as a place for storage, some parts are missing or broken, habit to go outside, no privacy, not enough water, impure, only for emergency, the pit is too small, religious reasons or any other reasons for nonusage of sanitary latrines, any problem arising out due to sanitary latrine, etc, The various reasons for convenience in open defecation such as one can roam around, meet/talk to people, see fields, and manure from feces were asked. The data were collected after taking informed written consent by the interview technique.

Ethical consideration

Ethical approval was obtained from the institutional ethics committee before starting the study (No. BPSGMCW/RC 455/ IEC /19).

Data analysis

The data were analyzed using the software R, version 3.6.2. Chi-square, Fisher's exact test and crude odds ratio (COR) (cutoff point for COR 1.5) with 95% confidence interval (CI), and P value were calculated. Adjusted odds ratio (AOR) with 95% CI, P < 0.05, was considered statistically significant.

Results

Of the 368 respondents having a toilet in their houses, 114 (30.97%) practiced open defecation. The prevalence of open defecation was 64.9% among scheduled caste as compared to 28.4% in other backward classes, and this difference was found statistically significant. The prevalence of open defecation was 42.7% among illiterates as compared to 37.5% among those educated up to primary level, this prevalence decreased as education level increased significantly. More than half of the laborers were defecating in open, followed by farmers and drivers. This difference was found statistically significant. Low monthly income showed a significant association with open defecation [Table 1].

Table 1: Sociodemographic profile of the study population (n=368)

Click here to view

[Table 2] shows that the prevalence of open defecation decreased significantly as time since the construction of latrine increased. Less than one-fourth of the study participants were using latrine if government resources were used in the construction of latrine as compared to 70.7% usage of latrine in self-made latrines. This difference was statistically significant.

Table 2: Factors associated with open defecation practice, (n=368)

Click here to view

Around three-fourth of the participants who rarely clean the latrine were defecating in open as compared to 16.6% of the participants who always clean the latrines. The difference in cleaning of the latrine was found statistically significant [Table 2].

[Table 3] describes the determinants of open defecation practice in the study area. The variables showed significant associations on univariate analysis were caste, educational status and occupation of the head of the family, family income, years since toilet constructed, resource of toilet construction, and toilet cleaning. The results of binary logistic regression (adjusted) analysis show that four of these predictor variables, caste, occupation of the head of the family, years since latrine constructed, and latrine cleaning remained significant predictors of open field defecation. The participants belonged to the scheduled caste were 2.88 times more likely to go for open field defecation than the participants of other castes. The cutoff point for bivariate analysis to be a candidate for multivariable analysis was <0.25. All the variables had P < 0.25 and so were transported to multivariable logistic regression to identify the risk factors.

Table 3: Determinants of open defecation practice in the study area

Click here to view

The farmers were 45.52 times and 6.18 times more likely to go for open field in comparison to those in jobs. The households owned latrine for <1 year and for 1–5 years were 45.52 times and 6.18 times more likely to go for the open field in comparison to those owned more than 10 years, respectively. Cleaning of latrine rarely and often was the powerful predictor of open field defecation with an AOR of 13.97 and 3.73, respectively [Table 3].

Almost one-third of the participants explained that they practiced open defecation because it was pleasurable, comfortable, or convenient, whereas 12% reported that it was a habit or tradition. The other common reasons for nonusages of latrines were convenience for an open environment for defecation, to meet friends, to see fields, and roaming around.

Discussion

In this study, we explored an in-depth understanding of the different factors responsible for open defecation. The prevalence of open defecation was seen in 30.97% of households, which is lesser than the previous studies conducted in North India and South India; the difference may be due to changed behavior toward toilet use with time.^[5],[7] The prevalence of nonusage of toilet is highest among scheduled caste as compared to other backward classes. The lack of sanitation practices among lower caste is indeed a function of lower economic well-being or education levels of the household. If the number of people is more as compared to the number of toilets, may cause few members of the house to defecate in open instead of having a toilet in the house. The findings were similar to a study which states that more number of family members and one toilet during morning hours forced household members to go out for defecation. As per the perception of the study participants feeling of the pit quickly, if every member used the toilet daily, was an important factor for open defecation.^[8],[9]

Two-fifth of the participants not using the toilet were illiterate. A higher level of education perhaps augments the income earning capacity of the household and its members. A well-educated person could spread the awareness about sanitation practices among his/her family members. Occupation is an important determinant which defines the prevalence of open defecation among houses having toilet. Occupation is directly linked to the income of the family and it has a negative relationship with open defecation, the lesser the income levels of a household head, the more the likelihood of its members practicing open defecation. Families with high income built more than one toilet in their house, and therefore, they do not need to deal with the problem of physical overcrowding. Farmers constituted the single largest group after unemployed ones whose heads are engaged in farming have a higher probability of defecating openly. The occupation of an individual determines one's source of income. During the rainy season or when the season is not favorable, farmers are unemployed for a greater part of the year which affects their incomes. There is also the likelihood of farmers not having the urge to construct toilet facilities at home since they spend their most of the time on farms during the farming season. Farmers and unemployed people constituted almost 50% of the population who were not using the latrines. As was expected, the income has a negative relationship with open defecation, the higher the income levels of a household head, the lesser the likelihood of its members practicing open defecation. The findings of low income, education, and occupation were similar to a study conducted by Yogananth and Bhatnagar in South India.^[9]

Households owned toilets for more than 10 years were utilizing more likely than owning toilets for 1 year or <1 year. This might be because the people are not able to give up their old habits and this seemed to be especially true for older members of the household. Similar findings were reported in a study done in South India.^[9]

Only a minority of all households in the study reported having received either money or materials from the government for latrine construction, whereas in 96.5% of households, the toilets were built without any government support. Toilets constructed with government support were more likely associated with open defecation. Households that built their own latrines are households that have more demand for latrines, possibly because of higher socioeconomic status, better education, and greater awareness of the health benefits. Toilets constructed with a government subsidy had a significant association with open defecation in other studies conducted in different parts of India.^{[8],[9],[10],[11],[12],[13]}

The common reason among the study participants for open defecation was convenience for an open environment for defecation to meet friends, see fields, and can roam around. In many studies done at different places, people felt comfortable continuing the childhood practice of morning walks^{[9],[14],[15]} and socializing with friends when going for open defecation.^{[8],[9],[13],[16],[17],[18]} Due to the shallow depth of many of the subsidized single pit latrine designs, some feared that if all members used the latrine all of the time, the small pit would quickly get filled. Some of the study participants were scared that their toilet pits will get filled very fast if all family members use it every day. Hence, they continue to go out to delay the toilet pit filling up.

Almost one-third of the participants who defecated in the open explained that they do so because it was pleasurable, comfortable, or convenient, whereas 11.9% told that it was habit or tradition to defecate in the open. Only 1.5% of people said that due to foul smelling of the toilet in the house, they preferred to go in the open to defecate. The poor drainage system in the village also leads to the nonusage of toilet as water comes on alternate days in the study village.

While the lack of sanitation may seem to be a basic problem with a seemingly easy solution, in reality, it is far more complex to implement successfully. There are underlying factors such as beliefs, old habits, and rituals that complicate the success of sanitation interventions and impact toilet uptake. Extensive research to understand the relationship between the dynamics of individuals and societal dynamics with regard to defecation and new sanitation behaviors is needed before implementation. These findings may help in the development of sustainable strategies for motivating people to build and use toilets in the study areas along with other parts of rural India.

Limitations

This study has several important limitations. The study has been conducted in a limited area and findings cannot be extrapolated on a larger scale. Furthermore, there is a possibility for social desirability bias, in self-reporting toilet use in spite of nonusage and reasons for nonuse. The temporal relationship between certain factors and defecation practices may not be clear owing to the cross-sectional design of the study. It is also possible that because the study was carried out in the rainy season, the use of latrines was higher than at other times in the year.

Conclusions and Recommendations

Open defecation is common among latrine owners in the study area. The availability of latrine in household is not enough to reduce open defecation. This behavior is associated with various several structural and sociocultural factors. The amount of money spent on government-supported toilet construction may not be sufficient for the preferred toilet design. The health education plays a key role in the promotion of latrine use, so the present sanitation campaign should consider shifting from toilet construction to toilet use. Policymakers must focus on large-scale campaigns to promote latrine use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Esrey SA, Potash JB, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 1991;69:609-21.
2.	Jacobson PD, Parmet WE. Public health and health care: Integration, disintegration, or eclipse. J Law Med Ethics 2018;46:940-51.
3.	Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health Organization, Geneva, 2008.
4.	Sources: “Swachh Bharat Mission (Gramin)”sbm.gov.in-Gramin Ministry of Drinking Water & Sanitation. Available from: http://www.swachhbharatmission.gov.in/SBMCMS/index.htm. [Last accessed on 2019 Sep 19].
5.	Coffey D, Gupta A, Hathi P, Khurana N, Srivastav N, Vyas S, et al. Revealed preference for open defecation: evidence from a new survey in rural north India. Econ Politic Wkly. 2014;49:43-55.
6.	World Bank WSP. Economic Impacts of Inadequate Sanitation in India – Flagship Report. The World Bank, Delhi, India: Water and Sanitation Programme; 2011.
7.	Hutton G. Global Costs and Benefits of Drinking-Water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage. WHO/HSE./WSH/12.01. Geneva: World Health Organization; 2012.
8.	Barnard S, Routray P, Majorin F, Peletz R, Boisson S, Sinha A, et al. Impact of Indian total sanitation campaign on latrine coverage and use: A cross-sectional study in Orissa three years following programme implementation. PLoS One 2013;8:e71438.
9.	Yogananth N, Bhatnagar T. Prevalence of open defecation among households with toilets and associated factors in rural south India: An analytical cross-sectional study. Trans R Soc Trop Med Hyg 2018;112:349-60.
10.	Coffey D, Gupta A, Hathi P, Spears D, Srivastav N, Vyas S. Understanding exceptionally poor sanitation in rural India: purity, pollution & untouchability. Econ Politic Wkly 2015:1-51.
11.	Coffey D, Gupta A, Hathi P, Khurana N, Spears D, Srivastav N, et al. Revealed preference for open defecation – Evidence from a new survey in rural North India. Econ Politic Wkly 2014;49:43-55.
12.	Jenkins MW, Freeman MC, Routray P. Measuring the safety of excreta disposal behavior in India with the new Safe San Index: Reliability, validity and utility. Int J Environ Res Public Health 2014;11:8319-46.
13.	Verma P, Pradyumna A, Prahlad IM. Reasons for continued practice of open defecation and non-use of constructed toilets in rural Madhya Pradesh. 2014. Available from: https://www.academia.edu/8614839/Reasons_for_continued_practice_of_open_defecation_and_non use_of_constructed_toilets_in_rural_Madhya_Pradesh_India. [Last accessed on 2020 Aug 29].
14.	Arnold BF, Khush RS, Ramaswamy P, London AG, Rajkumar P, Ramaprabha P, et al. Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci U S A 2010;107:22605-10.
15.	Kuberan A, Singh AK, Kasav JB, Prasad S, Surapaneni KM, Upadhyay V, et al. Water and sanitation hygiene knowledge, attitude, and practices among household members living in rural setting of India. J Nat Sci Biol Med 2015;6:S69-74.
16.	Bhardwaj A, Surana A, Mithra P, Singh A, Panesar S, Chikkara P. A community based cross sectional study on use of sanitary latrines in a rural setup in Maharashtra. Healthline 2013;4:89-93.
17.	Yimam YT, Gelaye KA, Chercos DH. Latrine utilization and associated factors among people living in rural areas of Denbia district, Northwest Ethiopia, 2013, a cross-sectional study. Pan Afr Med J 2014;18:334.
18.	Choudury N, Hossain MA. Exploring the current Status of Sanitary latrine use in shibpur Upazila, Narsingdi district. BRAC report. 2006. Available from: https://www.researchgate.net/publication/228375771. [Last accessed on 2020 Aug 29].