Investigators, led by an Indian-origin researcher, conducted a cluster randomised controlled trial in 80 rural villages in Madhya Pradesh to measure the effect of India's Total Sanitation campaign (an initiative to increase access to improved sanitation throughout rural India) on household latrine availability, defecation behaviours and child health.
A total of 5,209 children aged under 5 years and 3,039 households were involved in the study led by Sumeet Patil from the School of Public Health, University of California at Berkeley, and the Network for Engineering and Economics Research and Management in Mumbai.
The researchers found that the campaign intervention increased the percentage of households in a village with improved sanitation facilities by an average of 19 per cent. In the intervention villages, an average of 41 per cent of households had improved latrines compared to 22 per cent of households in the control villages.
The intervention also decreased the proportion of adults who self-reported the practice of open defecation from 84 per cent to 73 per cent. However, the authors also found that the intervention did not improve child health as measured on the basis of multiple health outcomes, including growth, prevalence of gastrointestinal illnesses and anaemia.
"Despite the limitations of the present study, including short follow-up and evidence for contamination in the control group, the results underscore the challenge of achieving adequately large levels of improvements in sanitation to deliver the expected health benefits within the scaled-up rural sanitation programmes," researchers said.
"There is an urgent need to continue to expand global understanding of what works, as well as what does not work, and keep focused on the important task of winning the sanitation battle," Clarissa Brocklehurst from the Gillings School of Global Public Health at Chapel Hill in North Carolina said.
"If generations of children are to be saved from the stunting and ill-health that poor sanitation causes, and generations of women and girls are to be saved from the indignity and risk that open defecation entails, then addressing sanitation must be one of India's highest priorities," she said. The study was published in the journal PLOS Medicine.