MASTER OF PUBLIC HEALTH IN SOCIAL EPIDEMIOLOGY

2014-16

SCHOOL OF HEALTH SYSTEM STUDIES

TATA INSTITUTE OF SOCIAL SCIENCES

MUMBAI

RURAL INTERNSHIP REPORT

INTERNSHIP ORGANISTION – VATSALYA

LUCKNOW DISTRICT, UTTAR PRADESH

Individual Study- Social issue and its health implications

A study on the WASH practices and the practice of open defecation, the

factors leading to this practice and its health implications in rural Lucknow

Under the guidance of: Submitted by:

Prof. Anil Kumar Dr. Akanksha Verma

Professor, School of M2014PHSE002

Health system studies

Tata Institute of Social Sciences

Mumbai

CONTENTS

1. ACKNOWLEDGEMENTS

2. ABSTRACT

3. INTRODUCTION

4. LITERATURE REVIEW

5. RATIONALE

6. AIMS

7. METHODOLOGY

8. RESULTS

9. DISCUSSION

10. CONCLUSION

11. RECOMMENDATIONS

12. REFERENCES

13. APPENDIX

Acknowledgement

At this juncture of the completion of my internship presentation and

report writing I would like to take this opportunity to express my heartfelt

gratitude to thank each and everyone who helped me during this

internship

First of all I would like to thank the Almighty for always showering his

blessings on me and giving me this life and all the other blessings.

I would also like to thank all the internship coordinators for giving us

this opportunity in the form of this rural internship to explore the new

facts and get new experiences in a rural setting.

I would also take this opportunity to sincerely thank Prof.Anil Kumar

sir for providing his valuable guidance and support throughout the period

of internship and helping me shape my vision and improve my skills and

also learn the intricacies of working in a very different setting

I would also like to thank School of health system studies, Mumbai for

the valuable support.

Also a sincere thanks to Vatsalya, Lucknow and especially Dr.Neelam

Singh for giving me this opportunity to be a part of such a respected

organisation and give me this opportunity to work in a different setting.

In the end I would like to thank my Family, especially my parents for

their tireless effort and support in making me capable to reach this stage

in my life.

Abstract

Objective: To study the level of awareness about the importance of various hygiene and

sanitation practices on the health of the individuals and also to assess the burden of open

defecation in the rural setting in Lucknow district and understand the various factors which

lead to the practice of open defecation in the community.

Methodology:

It was a systematic random sampling where the list of all the households in both the villages

was obtained from the ASHA and thus using systematic random sampling every 10th

household was selected. If the respondent was not available or not willing to participate then

the next household was selected

Results:

44% of the respondents had primary education, Majority of the respondent’s i.e around 57%

were employed as manual labourers whereas only a small section i.e 16.4% was in farming,

Around 64% of the male respondents were educated while taking into account the female

respondents around 49% of the female respondents were educated. For 78% of the

respondents the source of water was government while for the rest the source of water was

private and located in the same yard or the house where they were living. 52% of them said

they did not do anything to make it safe while 30% said that they always treated water to

make it safe for drinking while the rest 18% said that they did not treat the water regularly.

Around 59.9% of the respondents said that they were aware about the relationship between

safe drinking water and the reduction in the occurrence of diseases, Only around 34% of the

respondents had a toilet facility in their households while majority of them ie 66.4% did not

have any kind of toilet facility in their home. When asked whether the toilet facility was

functional or not about 77% of the respondents said that the toilet facility was non-functional

and it was used for other purposes like storage etc.

60% of the cases the respondents said that there was some member in the family who was

going out for open defecation. When the reason for going out for open defecation was asked ,

many themes like unavailability of the toilets, poverty or the lack of the resources to construct

a toilet, old norms of going out in the field and improperly constructed toilets and the feeling

of being suffocated inside a toilet were cited out.

Conclusion:

The most important themes which came to focus in this study were the old social norms and

the lack of the resources and poverty in constructing a toilet which was leading to the practice

of open defecation. Further it was also seen that in many of the cases even when the

respondent had adequate knowledge about the ill effects of open defecation, still they were

bound to go for open defecation because they had no other option. Although majority of the

respondents were well aware of the importance of maintaining hygiene they were not

practicing it due to various constraints like the social economic barriers etc.

Introduction

Prevention has been said to be much better than cure. One of the preventive strategies which

have been widely advocated to reduce the burden of diseases and remain healthy has been the

hygiene maintenance, sanitation practices and access to safe and clean drinking water. But only

the advocacy for these factors have shown to give very dismal and disappointing results and

there are many social, economic and cultural beliefs which act an impeding factors and

constrain the availability of safe hygiene, sanitation and water to a large section of the society.

One of the important issues have been the practice of open defecation meaning the practice of

defecating in the open in not a new term but has gained all the renewed focus and attention

presently.

According to some of the statistics there are around One billion people worldwide who still

practise "open defecation" which enhances their risk of risk of contaminating many of the

fatal diseases like cholera, diarrhoea, dysentery, hepatitis A and typhoid. This further leads to

highest numbers of deaths of children under 5 years old.

Although the global number of people who are still defecating in the open has dramatically

fallen from 1.3 billion in 1990, but still an alarming no. of the people coming to about one

billion people defecate in the open and supposedly 90 percent of these are living in rural areas

- "continue to defecate in gutters, behind bushes or in open water bodies, with no dignity or

privacy” (U.N study)

Although there has been a reduction in the prevalence of open defecation it can still be

considered as one of the most common problem in the fast-growing economies and thus, ever

increasing the total no. of people who are defecating in the open in absolute numbers.

This situation is alarming in India, where 64% of the population does have access to improved

sanitation. Of even more concern is the fact that almost half of people living in India practice

open defecation. And majority of them are residing in the rural areas which further in many

instances occurs as a double burden of poverty and ill health due to the practice of open

defecation.

India has to its credit more than twice the number of people who are defecating in the open

than accounting for the next 18 countries combined. Further taking some more statistics which

show that it accounts for 59 per cent of the 1.1 billion people in the world who practice open

defecation and added to this fact is the fact that India has around 97 million people without

access to improved sources of drinking water, second only to China.

Mohandas Gandhi said good sanitation was more important than independence

Open defecation is not only a matter of making toilets more available and accessible to the

masses but it is also a matter of human dignity and especially the dignity and respect of women

who face a dual burden of staking their dignity while going for open defecation and also making

them more vulnerable for the chances of being raped, lynched and being harassed while going

for open defecation.

Further it is not only a social issue but it also has major health implications and a heavy toll on

the no. of deaths especially for the children and the most vulnerable sections of the society.

It has been estimated that around 200,000 children in India die from diseases caused by faecal

contamination every year. Though studies have shown that open defecation has reduced by 31

percent since 1990, still about 300 million women and girls in India still have no other choice.

Diarrhoea and water-borne diseases have been well documented to be the leading causes of

mortality especially in developing countries and who defecate in the open are at a higher risk

of being contaminated with these deadly diseases.

Not only open defecation but also the WASH practices have been a neglected issue in Indian

sinereo especially in the rural settings where lack of awareness and practicing these leads to a

larger burden of diseases in the poorer sections of the society and in turn a heavy toll of

economic burden of treatment on the population and in turn on the public health system of the

country

There has been renewed focus on the attempts to improve WASH practices and sanitation

among the poorest sections and also on reducing the burden of open defecation but these have

long focused on building latrines.

India’s current prime minister says building toilets is a priority over temples. His administration

has set a goal of ending defecating in the open by 2019.

Prime Minister Modi has announced a well-publicized domestic program related to sanitation.

Called the Swachh Bharat scheme, the program aims at eliminating open defecation by

constructing toilets in every household in India by 2019.

But these strategies have seen to not show the desired results as mere physical construction of

toilets or making the safe drinking water and hygiene practices are not enough, what is requires

is the attitude and behavioural change which will lead to desired results.

Literature review:

Open defecation is not a new topic but it has definitely received renewed

attention in the recent decades.

One of the studies conducted by the WHO-UNICEF Joint Monitoring Program (JMP) for

Water and Sanitation, estimated that 36% of the world's total population, or around 2.5 billion

people, still lack access to an improved sanitation facility. This that a large proportion of the

world's people are living at risk of contamination due to enhanced exposure to a wide range

of infectious diseases because of open defecation (the WHO-UNICEF Joint Monitoring

Program (JMP) for Water and Sanitation)

Another study which was conducted to assess the levels of stunting in 112 districts of India

and also to explore the relationship between levels of open defecation and stunting. It was

seen that a 10 percent increase in open defecation was very significantly associated with a 0.7

percentage point increase in both stunting and severe stunting. (Mahershwari et al)

In another cross-sectional study where data was collected from villages in five states in India:

Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh, It was seen that most of the

respondents showed an increased preference for open defecation despite of the fact that

toilets were present in their households. (Timgire et al)

In another cross-sectional study which was conducted in 7 Government schools in Karnataka,

it was found that the mean knowledge score of personal hygiene was only 53.86 for girls

whereas it was much more that is 68.3 for the boys. It further revealed that the non-

availability of the toilets were one of the main reason for the higher drop-out among the girls

in the schools.(Ashutosh Shrestha and Mubashir Angolkar Department of Public Health, J.N.

Medical College, KLE University, Nehru Nagar, Belgaum, Karnataka, India )

In another study which was a school based study which was undertaken in children in a

government school in a rural area of north India with the objectives of finding out the

knowledge about personal hygiene. It was seen that there was a significant increase in the

performance among the students after some of the sessions were held on good habit of

washing their hands after using the toilet or latrine was given. Further it also was seen that

Most of the children used soap and water always to wash hands. (A school based survey on

hygiene in a rural area of northern India Harinder Sekhon Sukhmeet Minhas)

In another study which was conducted in villages under the Comprehensive Rural Health

Services Project (CRHSP), situated in Ballabgarh, Haryana which was to assess the level of

menstrual hygiene awareness among women between 15 to 49yrs of age it was seen that

majority of them (62%)were not aware of the reasons of mensus. Health sector had a very

minimal role in providing and disseminating knowledge regarding menstruation

Only 28.8% of women were using pads and of those who did not use napkins, only one in

every four women were willing to buy them. It was further it was seen that only some of the

respondents had some knowledge about the relationship between menstrual hygiene

maintenance and RTI.. ( A community-based study of menstrual hygiene practices and

willingness to pay for sanitary napkins among women of a rural community in northern India

PUNEET MISRA, RAVI PRAKASH UPADHYAY,VINITA SHARMA, KRISHNAN

ANAND, VIVEK GUPTA)

Another study focussing on sanitation in rural India revealed very high preference for open

defecation. Despite of the economic growth and income levels of the people there was a high

preference for going out for open defecation which had many social and cultural factors

associated with it like the old norms, values.

Poverty was also seen as one of the important determinant for the practice of open defecation

as lack of money forced the people especially in the rural settings to go for the practice of

open defecation. (Open Defecation Evidence from a New Survey in Rural North India

Diane Coffey, Aashish Gupta, Payal Hathi, Nidhi Khurana, Nikhil Srivastav, Sangita Vyas,

Dean Spears)

,

Rationale

The impact of poor water and hygiene practices has been known to be to have disastrous

effects especially for the infants and young children and also has a very huge impact on the

school going children. Despite fast rise in the economic growth and enhancement in the well-

being of the individuals especially in the upper sections of the society, still what has been

observed that a large section of this society especially residing in the rural areas still not only

have adequate access to safe drinking water, sanitation and hygiene practices but also a large

majority of the section residing in these areas defecate in the open.

India can very well be said the open defecation capital of the world as near about 60% of its

population still defecating in the open which further accounts for around 90% of those

residing in the rural areas of the country.

Though there has been a renewed commitment from both the government and the civil

society to put an end to this practice of open defection still there are various perceptions,

cultural, social practices which impede this and leads to the continuing practice of open

defecation in the country.

Another angle to this problem is the open defecation in the poorer sections of the society for

whom it is not only a matter of their cultural beliefs and practices but it is also a matter of

necessity in the dearth availability of the toilets or the unavailability of the funds required to

construct a toilet for use.

Not only open defecation but other WASH practices also play an important role in preventing

and reducing the burden of various diseases like diarrhoea, typhoid, and other diseases which

particularly re responsible for the majority of under 5 preventable deaths.

Open defecation is not only a health issue but also has a social angle to it in the form of

taking away the dignity of the women who have no option but to go for it and in turn making

them more vulnerable to being lynched and raped.

Further during doing the community profiling and mapping it was observed that around 35 to

49 % of the population still go for open defecation, many despite of the presence of a toilet.

Still it was seen that there is an interplay of not only the personal beliefs of the people who

go for open defecation but also various other factors which lead to this practice of open

defecation especially in a rural setting.

Therefore I proposed to study the factors which play a role enhancing the practice of open

defecation in a rural setting and also the level of awareness about the importance of safe

drinking water , maintaining hygiene and sanitation in reducing the stress and the burden of

the diseases,

Aim:

To study the level of awareness about the importance of various hygiene and sanitation

practices on the health of the individuals and also to assess the burden of open defecation in

the rural setting in Lucknow district and understand the various factors which lead to the

practice of open defecation in the community.

Objectives:

1. To understand the burden of open defecation in rural area

2. To study the factors leading to open defecation in the rural setting

3. To study the various water hygiene and sanitation practices followed in the

community

4. To assess the level of awareness among the adolescents about the importance of

menstrual hygiene maintenance

5. To study the level of awareness about the importance of the availability of safe

drinking water and hygiene and sanitation practices in reducing the burden of diseases

in the community

,

Research methodology

1. Universe of study:

Bithauli Khurd village and Raipur village in Bithauli Khurd panchayat in Chinhat block of

Lucknow district in western Uttar Pradesh

2. Type of Study:

It was a cross sectional study

3. Sampling frame :

Households in the village of Bithauli Khurd and Raipur village in Bithauli Khurd panchayat

4. Sampling:

It was a systematic random sampling where the list of all the households in both the villages

was obtained from the ASHA and thus using systematic random sampling every 10th

household was selected. If the respondent was not available or not willing to participate then

the next household was selected.

5. Sample size:

A total of 72 households were selected using systematic random sampling

6. Methods of data collection:

A mixed method was used for the data collection which included face to face interviews

with 72 respondents in the two villages and also 3 focussed group discussions and 4 key

informant interviews were also carried out.

7. Tool used:

Semi-structured interview schedule was used which was translated and conducted in Hindi.

Secondary data was also obtained from the health professionals and the other frontline

workers. 3 focussed group discussions as well as 4 key informant interviews were also

conducted

Ethical consideration: Verbal consent was taken from the respondents prior to the interview

and participation was made voluntary. Respondents were made aware of the recordings to be

done for the purpose of analysis and were assured of confidentiality. Participants were free not

to answer any question with which they were not comfortable and could leave the interview at

any point of time

Results

Educatonal status of the respondent: in percentage

Taking into account the educational status of the respondents majority i.e. 44% of the

respondents had primary education while around 18% of the respondents had middle

education and only a small section of the respondents around 4% had higher

education.around 30% of the rspondents had no formal education

Occupation of head of the household:

Majority of the respondent’s i.e around 57% were employed as manual labourers whereas

only a small section i.e 16.4% was in farming. Around 19% of the respondents were

unemployed and the rest were employed in other sectors

0 10 20 30 40 50 60

manual labour

farming

unemployed

others

56.6

16.4

18.8

8.2

occupation of the head of the household

Literacy rate:

Males

63.4%

Female

48.9%

Total

52.4%

Around 64% of the male respondents were educated while taking into account the female

respondents around 49% of the female respondents were educated

Source of water-government 78% private 22%

For 78% of the respondents the source of water was government while for the rest the source

of water was private and located in the same yard or the house where they were living

Water safe for drinking?

78%

When asked whether the water is safe for drinking majority i.e 56% of the respondents said

that they do not think that the water was safe for drinking while 10% said yes the water they

used was safe for drinking while the rest said that they had no idea about the quality of water

Treat water to make it safe

When the respondents were asked whether they do anything to make it safe around 52% of

them said they did not do anything to make it safe while 30% said that they always treated

water to make it safe for drinking while the rest 18% said that they did not treat the water

regularly ,it was in certain seasons that they treated the water to make it safe.

Reason for not treating water

Time and resources were the two main constraints which prevented the respondents from

treating water with any of the methods

52%18%

30%

treat water to make it safe

Methods of water treatment

Majority of the respondents’ i.e 29% of them said that they boiled the water in order to make

it safe for drinking while the rest 6.7% said that they used the chlorine tablets provided to

them to make the water safe for drinking while 14.4% of the respondents said that they used

some other methods like filtration to make the water safe for drinking

Has the water ever been tested by the government officials

Majority of the respondents’ i.e 50% of them said that the water has never been tested by the

government officials while only 13.3% of the respondents said that the water was ever tested

by the government officials while 37% of them said that they have no idea whether the water

was ever tested by the officials or not

Awareness about the relationship between safe drinking water and diseases

Around 59.9% of the respondents said that they were aware about the relationship between

safe drinking water and the reduction in the occurrence of diseases, while 24.4% said that

they had no idea about this relationship and 15.7% said that they were unaware about this

relationship.

Information provided by the health providers

Majority of the respondents said that they were not provided with any information about the

relationship between safe drinking water and the occurrence of disease and also about the

methods to keep the drinking water clean

A strong association (p=0.000) was observed in between the educational status of the

respondent and whether they did anything to make the water safe for drinking.

Educational status of the respondents especially the female respondent was seen to have

a positive impact on increasing the frequency of treating water to make it safer for

drinking

Another important association which was seen was between the prior knowledge or

awareness about the relationship between safe drinking water and the occurrence of the

disease and frequency of making it safe for drinking using any of the methods (p=0.001)

Another important association was seen between the prior knowledge or awareness

about the relationship between safe drinking water and the occurrence of the disease

and frequency of changing the water kept in the utensils used for drinking (p=0.002)

Clean utensil for drinking water daily

Around 66% of the respondents said that they did not clean the utensil used for keeping

drinking water regularly while 35.6% of the respondents said that they cleaned the utensils

regularly.

Episode of diarrhoea in the past

46.6% of the respondents said that there was an episode of diarrhoea in the past one month

and one of the family members was affected while 43.4% said that they did not have any

episode of diarrhoea in the past one month in the family. Those who reported to have an

N O

Y E S

66.4

35.6

CLEAN UTENSIL USED FOR KEEPING DRINKING WATER DAILY

episode of diarrhoeas said that in majority of the caes it was the children below the age of 6

yrs who had any episode of diarrhoea

Do you bathe daily

86.8% of the respondents said that they bathe daily while 13.4% of the repondents said that

they did not bathe daily. When asked about the knowledge about the importance of bathing in

maintaining personal hygiene majority of the respondents’ i.e 89.6% said that they were

aware about the importance of bathing in maintaining personal hygiene

N O

Y E S

43.4

46.6

EPISODE OF DIARRHOEA IN THE PAST ONE MONTH

0 20 40 60 80 100

yes

no

do you bathe daily

Children wash hands before eating

88.3% of the respondents said that their children regularly wash hand before eating food

while rest said that their children did not wash hands before eating food

Majority of the repondents said that they washed hands before cooking food for the family while only

a small section ie 2.7% said that they did not wash hands before cooking food

When the respondents were asked that whether the children washed hands after defecation 81.7% of

the respondents said that the children regularly washed hands after defecation while the rest said that

their children did not wash hands after defecation

0 20 40 60 80 100

yes

no

97.3

2.7

wash hands before cooking

0 20 40 60 80 100

yes

no

81.7

18.3

yes no

Series1 81.7 18.3

Children wash hands after defecation

What is done with the infant’s faeces

When the respondents were asked that what they did with the faeces of the infants, the

majority of them said that they would throw the faeces into open, only a small portion said

that they properly disposed the faeces

Methods of washing hands after disposal of faeces

The most frequent method of washing hands after the disposal of the faeces was using ash

and water to wash hands while only a small section of the respondents said that they properly

washed their hands with soap and water

Knowledge about importance of menstrual hygiene:

66.7% of the respondents said that they were aware about the importance of menstrual

hygiene and its importance in keeping one self-healthy while 33.3% of the respondents said

that they were not aware about it.

0 10 20 30 40 50 60

yes

no

41.7

58.3

yes no

Series1 41.7 58.3

menstrual hygiene maintance and its relation with reproductive tract infection

When asked about the awareness about the causal relationship between menstrual hygiene

maintenance and the occurrence of reproductive tract infection 58.5% of the respondents said

that they were aware about it.

When the respondents were asked that were they provided any information by the health

workers , majority of the respondents i.e 81% said that they were not provided with any

information by the frontline workers

Toilet facility in the household

Only around 34% of the respondents had a toilet facility in their households while majority of

them ie 66.4% did not have any kind of toilet facility in their home.

When asked whether the toilet facility was functional or not about 77% of the respondents

said that the toilet facility was non-functional and it was used for other purposes like storage

etc

N O

Y E S

66.4

33.6

TOILET FACILITY PRESENT IN THE HOUSE

Going for open defecation

In about 60% of the cases the respondents said that there was some member in the family

who was going out for open defecation. When the reason for going out for open defecation

was asked , many themes like unavailability of the toilets, poverty or the lack of the resources

to construct a toilet, old norms of going out in the field and improperly constructed toilets and

the feeling of being suffocated inside a toilet were cited out.

Reason for going for open defecation

0 10 20 30 40 50 60 70

no

yes

going for open defecation

T O I L E T S N O T P R E S E N T

T O I L E T S N O T P R O P E R L Y C O N S T R U C T E D

O L D N O R M S

M O R E C O M F O R T A B L E

F E E L S U F F O C A T E D I N T O I L E T S

36

16

66

54

45

REASON FOR GOING FOR OPEN DEFECATION

Reason for not using toilets

In most of the cases the respondents said that they felt that the toilets were unhygienic, also

they felt more comfortable in going out for defecation and also they felt suffocated inside the

toilets

Should women go out for open defecation

In majority of the cases the respondents said that they think women should not go out for

open defecation because they felt it was not safe for them. But majority of the respondents

also said that they had no option but to go out for open defecation as there were no toilets

available for use.

16

66

54

45

T O I L E T S N O T P R O P E R L Y C O N S T R U C T E D

T O I L E T S A R E U N H Y G I E N I C

F E E L L E S S C O M F O R T A B L E

F E E L S U F F O C A T E D I N T O I L E T S

CHART TITLE

21.8

78.2

Y E S

N O

SHOULD WOMEN GO FOR OPEN DEFECATION

18.9

46.3

9

28.5

I T I S S A F E F O R T H E M

T H E Y D O N O T H A V E A N Y O P T I O N

I T I S M O R E H Y G I E N I C

I T I S N O T S A F E

PERCEPTION ABOUT WOMEN GOING FOR OPEN DEFECATION

Separate toilets are there for boys and girls in the schools

61.7% of the respondents said that they did not have any separate toilet facilities for the boys

and the girls in the schools

Are they functional?

76.3% of the respondents said that the toilets present in the schools were not functional and

this was cited as one of the most important reason for the higher no of school dropouts among

the girls. It also came to focus that in majority of the cases the girls did not have separate

space in the schools to change sanitary napkin

38.3

61.7

Y E S

N O

SEPERATE TOILETS FOR BOYS AND GIRLS IS PRESENT IN THE SCHOOLS

1

2

3

0

0

76.3

23.7

ARE THE TOILETS FUNCTIONAL

Series1 Series2

Discussion

Majority of the respondents. i.e 44% had primary education while around 18% of the

respondents had middle education and only a small section of the respondents around 4% had

higher education.around 30% of the rspondents had no formal education

Majority of the respondent’s i.e around 57% were employed as manual labourers whereas

only a small section i.e 16.4% was in farming. Around 19% of the respondents were

unemployed and there rest were employed in other sectors

78% of the respondents had the source of water was government while for the rest the source

of water was private and located in the same yard or the house where they were living 56% of

the respondents said that they do not think that the water was safe for drinking while 10%

said yes the water they used was safe for drinking while the rest said that they had no idea

about the quality of water 52% of them said they did not do anything to make it safe while

30% said that they always treated water to make it safe for drinking while the rest 18% said

that they did not treat the water regularly, it was in certain seasons that they treated the water

to make it safe.

Time and resources were the two main constraints which prevented the respondents from

treating water with any of the methods

Majority of the respondents’ i.e 29% of them said that they boiled the water in order to make

it safe for drinking while the rest 6.7% said that they used the chlorine tablets provided to

them to make the water safe for drinking while 14.4% of the respondents said that they used

some other methods like filtration to make the water safe for drinking

Around 59.9% of the respondents said that they were aware about the relationship between

safe drinking water and the reduction in the occurrence of diseases, while 24.4% said that

they had no idea about this relationship and 15.7% said that they were unaware about this

relationship.

Majority of the respondents said that they were not provided with any information about the

relationship between safe drinking water and the occurrence of disease and also about the

methods to keep the drinking water clean

A strong association (p=0.000) was observed in between the educational status of the

respondent and whether they did anything to make the water safe for drinking.

Educational status of the respondents especially the female respondent was seen to have

a positive impact on increasing the frequency of treating water to make it safer for

drinking

Another important association which was seen was between the prior knowledge or

awareness about the relationship between safe drinking water and the occurrence of the

disease and frequency of making it safe for drinking using any of the methods (p=0.001)

Another important association was seen between the prior knowledge or awareness

about the relationship between safe drinking water and the occurrence of the disease

and frequency of changing the water kept in the utensils used for drinking (p=0.002)

46.6% of the respondents said that there was an episode of diarrhoea in the past one month

and one of the family members was affected while 43.4% said that they did not have any

episode of diarrhoea in the past one month in the family. Those who reported to have an

episode of diarrhoeas said that in majority of the caes it was the children below the age of 6

yrs who had any episode of diarrhoea

The most frequent method of washing hands after the disposal of the faeces was using ash

and water to wash hands while only a small section of the respondents said that they properly

washed their hands with soap and water. 66.7% of the respondents said that they were aware

about the importance of menstrual hygiene and its importance in keeping one self-healthy

while 33.3% of the respondents said that they were not aware about it.

When asked about the awareness about the causal relationship between menstrual hygiene

maintenance and the occurrence of reproductive tract infection 58.5% of the respondents said

that they were aware about it.

Only around 34% of the respondents had a toilet facility in their households while majority of

them ie 66.4% did not have any kind of toilet facility in their home.

When asked whether the toilet facility was functional or not about 77% of the respondents

said that the toilet facility was non-functional and it was used for other purposes like storage

etc

In about 60% of the cases the respondents said that there was some member in the family

who was going out for open defecation. When the reason for going out for open defecation

was asked , many themes like unavailability of the toilets, poverty or the lack of the resources

to construct a toilet, old norms of going out in the field and improperly constructed toilets and

the feeling of being suffocated inside a toilet were cited out.

In most of the cases the respondents said that they felt that the toilets were unhygienic, also

they felt more comfortable in going out for defecation and also they felt suffocated inside the

toilets

In majority of the cases the respondents said that they think women should not go out for

open defecation because they felt it was not safe for them. but majority of the respondents

also said that they had no option but to go out for open defecation as there were no toilets

available for use.

While performing FGD major themes which came into focus were poverty ie the lack of

resources to construct a toilet.

One of the respondent said that “ paisa nahi hai banana ko toh insaan kya karega , khule

mein hi toh jayega”.ie he has that as there is no money to construct a toilet we are bound to

go for open defecation

Another respondent said that “ Pradhan paisa hi ani deta shauchalya banana ko saara

paisa khud hi rakh leta hai toh kya kare” ie the gram Pradhan does not give the money to

construct a toiliet and indeed keeps the whole amount with himself so from where we will

construct the toilet.

Another woman said that [latrines] that you get from the government are no use, they are so

small…their pits are so small that in two or three months they will fill up. There will be bad

smells and filth in the surroundings. For peoplewho don’t have much land, wouldn’t they

make a house rather than a latrine? [If they made latrines] it would be dirty.”

Another man said that “The Pradhan made this [latrine]. If we’d made it, we’d have made it

the way we wanted. All of this IndiraVikasmoney has come, so the pradhanhas made it. But

he only got a very little pit dug.

If we made it the way we wanted, then wouldn’t we have used a whole room full of bricks?

How can a poor man…? It costs 20 or 25 thousand rupees [make a latrine].”

Another 72yrs old man said “I do not want to go inside the latrine... one benefit of going out

in open is that one can have some exercise and the second is that all the impurities of one’s

breath get out...

but if one eats and drinks and goes to the latrine in the house one would not live long.... this is

the reason why people in the villages live long—for 100 years—and the people in the cities

live only 60, 70, 80 or 85 years.”

Another respondent said that “[By defecating in the open] one can stretch the body, one can

go out for a walk. You can also prevent yourself from getting diseases. If a latrine is in the

house, bad smells will come, germs will grow.

Latrines in the house are like…hell. The environment becomes completely polluted. There is

no benefit of lighting a diya, no benefit at all.”

Conclusion:

The most important themes which came to focus in this study were the old social norms and

the lack of the resources and poverty in constructing a toilet which was leading to the practice

of open defecation. Further it was also seen that in many of the cases even when the

respondent had adequate knowledge about the ill effects of open defecation, still they were

bound to go for open defecation because they had no other option. Although majority of the

respondents were well aware of the importance of maintaining hygiene they were not

practicing it due to various constraints like the social economic barriers etc.

Recommendations:

SHORT TERM STRATEGIES:

1. Distributing chlorine drops throughout the year every year to each and every

household and asking them to put in drinking water regularly. 2. Street plays should be done to tell them about the importance of hand washing, safe

drinking water and harmful effects of open defection

3. Sanitation week" to be organised every week from 2nd October to 9th October ( for

one week) where advocacy done by street plays for awareness

4. More dissemination of the awareness about the ill effects of open defecation and the

positive impact of sanitation and hygiene maintenance

Long term strategies

1. More research need to be done to see the effectiveness of the toilets

2. Better monitoring of the government schemes in order to build better toilets

References:

1. Unicef.in, (2015). Eliminate Open Defecation | UNICEF. 6 Oct. 2015

2. Tsc.gov.in, (2015). ABOUT NBA.

3. What explains widespread open defecation in India? (2015 ) SangitaVyas & Dean

Spears

4. Strategic communication for total sanitation campaign. (2015).

5. .Long, Jeanne et al, (2013) ‘WASH in Schools Empowers Girls’ Education in Rural

Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools’,

United Nations Children’s Fund,

6. Evaluation Study on Total Sanitation Campaign, planning commission(2013)

Appendix:

1. Where do you fetch water from

a. Govt

b. Private

2. Do you think the water available is safe for drinking

a. Yes

b. No

3. How can you say that water is not safe for drinking?

a. Color is pale

b. Odour is present

c. Others

4. Do you do anything to make it safe

a. Yes

b. no

5. If yes what do you do to make it safe

a. Nothing

b. Boil

c. Add alum

d. Use filter

e. other

6. Why don’t you do anything to make it safe

a. No time

b. No resources

c. Other

d. Don’t know

7. Have health providers given any information about the importance of safe drinking

water

a. Yes

b. No

8. Do you know any health implications of unsafe drinking water

a. Yes

b. No

9. Do you change the water used for drinking everyday

a. Yes

b. no

10. Do you clean the utensil in which you store water

a. Yes

b. no

11. where do you keep the water used for drinking

a. in the same container which is used for other things

b. in a separate container

12. Has any of the family member had any episode of diarrhoea, cholera, and jaundice

in the past two months?

a. Yes

b. No

Questions about the sanitation practices done in the community and the perception of

the providers and the beneficiaries

13. Do you have toilet facility in your household

a. Yes

b. no

14. Was it constructed by yourself or by the government

a. Self constructed

b. Government

15. If yes, are they functional,

a. Yes

b. No

16. If no, the reason for not using them

a. Not constructed properly

b. Doesn’t have adequate space

c. Old norms

d. Doesn’t have proper facilities

17. Do any of your family members go for open defecation

a. Yes

b. no

18. If yes, what are the reasons for doing so

a. Old norms

b. Improper constructed toilets

c. Ease of use

d. Personal reasons

19. Do you use toilets constructed at your home

a. Yes

b. no

20. If no, what do you use it for

a. Storage purpose

b. Other uses

21. Do you know the consequences of defecating in the open?

a. Yes

b. no

22. If yes, what are these

a. Increase prevalence of diseases

b. Infected food and surroundings

c. Others

23. Have the health workers provided information about the ill effects of defecating in

the open

a. Yes

b. No

24. Do schools have toilets for both boys and girls

a. Yes

b. no

25. If yes , are they regularly used by both girls and boys

a. Yes

b. no

26. If no, reasons

27. Are they regularly cleaned

a. Yes

b. no

Questions on hygiene practices followed and the perception of the population

28. What do you do to keep yourself and your surroundings clean

a. Regularly keep the surroundings clean

b. Clean the drains

29. Do you wash bathe daily

a. Yes

b. No

30. Do you wash hands before cooking

a. Yes

b. No

31. Do children wash hands before eating

c. Yes

d. No

32. Do children wash hands after defecation

e. Yes

f. No

33. Do you know that how to maintain menstrual hygiene

a. Yes

b. no

34. Do you wash hands after changing pads

a. Yes

b. no

35. Do you wash hands before changing pads

c. Yes

d. no

Questions to assess the perceptions of men on sanitation issues

36. Do you think that construction of toilets is important especially for the women of

your house?

a. Yes

b. no

37. Do you think that it is safe for women to go out for open defecation

a. Yes

b. No

38. Do you know about the causal relationship between maintaining menstrual hygiene

and its health consequences

a. Yes

b. No

39. If yes , do you think that men have a role in menstrual hygiene of women

a. Yes

b. No

40. What is the role of the men in menstrual hygiene management

a. Economic support

b. Provide space

c. Proper nutrition