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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 620-623

Open defecation practice in twenty remote villages located in South India: A population-based cross-sectional study


Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India

Date of Submission06-Jun-2020
Date of Decision19-Dec-2020
Date of Acceptance07-Mar-2021
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Mohandas Roselin
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet - 605 014, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_217_20

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  Abstract 


Introduction: Open defecation practice is a major public health problem in India. We intended to study the practice of open defecation and its related risk factors in a rural area of South India. Methodology: This study was conducted in twenty villages surrounding a rural health training center, located in Tamil Nadu. Data collection was done by medical interns and medical social workers using a structured questionnaire. Results: The total population surveyed was 14,925, of which 14,061 individuals were in the age group of 5 years and above. Among them, 9069 (64% [63–65]) individuals were practicing open defecation. When compared to backward caste, individuals belonging to the most backward caste were 10% more likely (adjusted prevalence ratio [aPR]: 1.1 [1.0–1.2]) and individuals belonging to scheduled caste were 40% more likely (aPR: 1.4 [1.3–1.5]) to be practicing open defecation. With increase in age, there was a decrease in the prevalence of open defecation practice by 1% (aPR: 0.99 [0.99–0.99]) and with increase in family members, there was a decrease in the prevalence of open defecation practice by 2% (aPR: 0.98 [0.96–0.99]). Illiterate people had 14% higher chance of preferring open defecation (aPR: 1.14 [1.07–1.2]). Tobacco users were 10% more likely (aPR: 1.1 [1.0–1.3]) to be associated with the open defecation practice and nonvegetarians were 20% more likely to be associated with the open defecation practice (aPR: 1.2 [1.1–1.3]). When compared to kutcha house individuals, pucca house individuals were 10% less likely (aPR: 0.9 [0.8–1.0]) and semi-puccca house individuals were 10% more likely (aPR: 1.1 [1.0–1.2]) to adopt open defecation method. Gender, marital status, and hypertension were not associated with the open defecation practice. Conclusion: Open defecation practice is still continuing as an important public health problem in remote rural areas of South India.

Keywords: Open defecation, remote villages, South India


How to cite this article:
Roselin M, Newtonraj A, Girija G, Manikandan M, Vincent A. Open defecation practice in twenty remote villages located in South India: A population-based cross-sectional study. J Datta Meghe Inst Med Sci Univ 2022;17:620-3

How to cite this URL:
Roselin M, Newtonraj A, Girija G, Manikandan M, Vincent A. Open defecation practice in twenty remote villages located in South India: A population-based cross-sectional study. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:620-3. Available from: http://www.journaldmims.com/text.asp?2022/17/3/620/360192




  Introduction Top


Open defecation practice is a major public health problem in India. As per the National Family Health Survey 4 data-2016, improved sanitation facility prevalence was found to be 70% in urban areas and only 34% in rural areas and in total, it was found to be 52%.[1] Children are mostly affected by open defecation and poor sanitation, which results in conditions ranging from stunting to cholera and malnutrition.[2] Increased risk of sexual exploitation and psychosocial stressors are associated with open defecation, due to poor sanitation in rural communities.[3] In recent years, India has made rapid progress in ending open defecation and focuses mainly on improving water, sanitation, and hygiene.[4] In India, 36 states and union territories, 706 districts, and over 603,175 villages have been declared open defecation free (ODF) as of January 2020.[4] The Swachh Bharat Mission (Gramin) and the Swachh Bharat Mission (Urban) launched in 2014 aimed to achieve ODF India by 2019 (Making Gram Panchayats ODF, clean, and sanitized), but is still pending.[5] The Pradhan Mantri Awas Yojana (Urban) Mission launched on June 25, 2015, which also intends to provide housing for all in urban areas by year 2022, also has some impact on open defecation practice.[6],[7] Despite the above-mentioned government initiatives, people are still lacking their awareness regarding the importance of the usage of sanitary latrines and continue to practice open defecation, especially in our field practice area, moreover government health system also unable penetrate the remote rural and to bring behavioral change in the community. This study was carried out to identify the prevalence and potential risk factors associated with open defecation practice in a remote rural area and thus the impact of government programs on preventing open defecation in a remote rural area of South India [Table 1].
Table 1: Association between type of house and open defecation practice with other risk factors in a remote rural area of South India in 2018

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  Methodology Top


This study was conducted in a remote rural area located in Chengalpattu district in South India. This study covered twenty villages and around 15,000 population. This study was carried out at a rural health training center. Universal sampling method was adopted where all the individuals in the age group of 5 years and above, belonging to these twenty villages, were included. Data were collected from March 2018 to October 2018. Data were collected using a structured pilot-tested questionnaire with the help of medical interns and medical social workers. Data collection and the study procedure were supervised by a faculty from the department of community medicine. After data collection, the data were entered in EpiData software version 3.1 (Denmark, Europe).[8] The quality of the data collected was ensured by checking a subset of data collected by the faculty in the field. The data were analyzed using SPSS version 22 and STATA version 14 (StataCorp LLC, Texas, USA).[9],[10] Ethical approval was obtained from the institute's ethics board for the study and dissemination of information (ref no. RC 100/18).


  Results Top


The total population surveyed was 14,925, of which 14,061 individuals were in the age group of 5 years and above. Among them, 9069 (64% [63–65]) individuals were practicing open defecation. When compared to individuals belonging to backward caste, individuals belonging to the most backward caste (MBC) were 10% more likely (adjusted prevalence ratio [aPR]: 1.1 [1.0–1.2]) and individuals belonging to scheduled caste (SC) were 40% more (aPR: 1.4 [1.3–1.5]) likely to be practicing open defecation. With increase in age, there was a decrease in the prevalence of open defecation practice by 1% (aPR: 0.99 [0.99–0.99]) and with increase in family members, there was a decrease in the prevalence of open defecation practice by 2% (aPR: 0.98 [0.96–0.99]). Illiterate people had 14% higher chance of preferring open defecation practice (aPR: 1.14 [1.07–1.2]). Tobacco users were 10% more likely (aPR: 1.1 [1.0–1.3]) to be associated with the open defecation practice and nonvegetarians were 20% more likely to be associated with the open defecation practice (aPR: 1.2 [1.1–1.3]). When compared to the kutcha house individuals, pucca house individuals were 10% less likely (aPR: 0.9 [0.8–1.0]) and semi-pucca house individuals were 10% more likely (aPR: 1.1 [1.0–1.2]) to adopt the open defecation method. Gender, marital status, and hypertension were not associated with the open defecation practice.


  Discussion Top


The significant finding in our study was that 64% of the individuals practice open defecation, whereas in an analytical cross-sectional study done in rural South India, it was found that 54.8% of the individuals practice open defecation.[11] Another important finding was that those who belong to low social status, who were illiterate, and those with poor housing conditions were associated with open defecation practices. In our study, the prevalence of open defecation practiced by both males and females was almost the same and in few other studies, males practice open defecation more commonly than females.[12],[13] In our study, low literacy was associated with open defecation practice and few other studies also showed similar results, whereas in some studies, it was found that districts with high female literacy were found to have less stunting, where stunting is directly related to open defecation practices.[14],[15] Another notable finding in our study was that tobacco users, alcoholics, and nonvegetarians were associated with the open defecation practice. In our study, it was demonstrated that families belonging to the MBC and SC with low socioeconomic status and living in kutcha and semi-pucca houses were more likely to be associated with the open defecation practice. A similar study conducted in the rural parts of Uttar Pradesh, India, showed that the practice of open defecation and residing in kutcha house highly predispose individuals to acquire soil-transmitted helminthic infections.[16] Studies have shown that maintaining good sanitation practices, improving the quality of water source, and implementing household water storage prevent the contamination of water.[17] Another important study showed that gender-based stress among females following open defecation practices leads to psychosocial stress among them.[18]

The large population-based data covering population residing in a remote rural area is an important strength of the present study. The limitation of our study was that we could not meet all the individuals, but the details were collected from their family members in the case of nonavailability of the participants. Policy implications in our study were that our study provides valuable information on the current status of open defecation practices and their related risk factors so that public health policies could be planned accordingly. In rural communities, by improving people's social status and ensuring permanent houses for every single family, their unhealthy practices could be averted, and our study also highlights the gap between the government target and the situation on ground. Apart from government programs, nongovernmental organizations and public health experts need to work in grassroot level to find out the risk factors and to make behavioral change in the community.


  Conclusion Top


Open defecation practice is still continuing as an important public health problem in remote rural areas of South India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ministry of Health and Family Welfare-Government of India. National Family Health Survey; 2016. Available from: http://rchiips.org/NFHS/pdf/NFHS4/TN_FactSheet.pdf. [Last accessed on 2020 Jun 05].  Back to cited text no. 1
    
2.
Children and Sanitation: The Effects of Open Defecation – Community Led Total Sanitation Foundation. Available from: http://www.cltsfoundation. Org/children-and-sanitation-the-effects-of-open-defecation. [Last accessed on 2020 Jun 05].  Back to cited text no. 2
    
3.
Saleem M, Burdett T, Heaslip V. Health and social impacts of open defecation on women: A systematic review. BMC Public Health 2019;19:158.  Back to cited text no. 3
    
4.
An Open Defecation Free India | UNICEF India. Available from: https://www.unicef.org/india/what-we-do/ending-open-defecation. [Last accessed on 2020 Jun 05].  Back to cited text no. 4
    
5.
Ministry of Drinking Water and Sanitation. Guidelines for Swachh Bharat Mission - Gramin; 2017. Available from: http://swachhbharatmission.gov.in/sbmcms/writereaddata/images/pdf/Guidelines/Complete -set-guidelines.pdf. [Last accessed on 2020 Jun 05].  Back to cited text no. 5
    
6.
Ministry of Housing and Urban Affairs-Government of India. Pradhan Mantri Awas Yojana-(Urban); 2019. Available from: https://pmaymis.gov.in/assets/pdf/book.pdf. [Last accessed on 2020 Jun 05].  Back to cited text no. 6
    
7.
Ministry of Rural Development-Government of India. Pradhan Mantri Awas Yojana-Gramin. India Natl Informatics Cent 2020. Available from: https://vikaspedia.in/social-welfare/rural-poverty-alleviation-1/schemes/indira-aawas-yojna. [Last accessed on 2020 Jun 05].  Back to cited text no. 7
    
8.
Epidata Association. Epidata Software; 2014. Available from: https://www.epidata.dk. [Last accessed on 2020 Jun 05].  Back to cited text no. 8
    
9.
IBM Corporation. IBM SPSS Statistics, India; 1989. Available from: https://www.ibm.com/in-en/analytics/products. [Last accessed on 2020 Jun 05].  Back to cited text no. 9
    
10.
StataCorp LP. Stata data analysis and statistical software. Spec Ed Release 2007;10:733.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
    
12.
Biran A, Jenkins MW, Dabrase P, Bhagwat I. Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India. Trop Med Int Health 2011;16:854-62.  Back to cited text no. 12
    
13.
Vyas S, Srivastav N, Mary D, Goel N, Srinivasan S, Tannirkulam A, et al. Measuring open defecation in India using survey questions: Evidence from a randomised survey experiment. BMJ Open 2019;9:e030152.  Back to cited text no. 13
    
14.
Spears D, Ghosh A, Cumming O. Open defecation and childhood stunting in India: An ecological analysis of new data from 112 districts. PLoS One 2013;8:e73784.  Back to cited text no. 14
    
15.
Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India: A cross-sectional analysis of surveys. BMJ Open 2015;5:e005180.  Back to cited text no. 15
    
16.
Ganguly S, Barkataki S, Karmakar S, Sanga P, Boopathi K, Kanagasabai K, et al. High prevalence of soil-transmitted helminth infections among primary school children, Uttar Pradesh, India, 2015. Infect Dis Poverty 2017;6:139.  Back to cited text no. 16
    
17.
McGuinness SL, O'Toole J, Barker SF, Forbes AB, Boving TB, Giriyan A, et al. Household water storage management, hygiene practices, and associated drinking water quality in rural India. Environ Sci Technol 2020;54:4963-73.  Back to cited text no. 17
    
18.
Sahoo KC, Hulland KR, Caruso BA, Swain R, Freeman MC, Panigrahi P, et al. Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India. Soc Sci Med 2015;139:80-9.  Back to cited text no. 18
    



 
 
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