1. 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
3. 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.
4. 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.
5. 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.
6. 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.
7. 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)
8. 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)
,
9. 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,
10. 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
,
11. 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
12. 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
13. 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%
14. 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
15. 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
16. 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
17. 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
NO
Y E S
66.4
35.6
CLEAN UTENSIL USED FOR KEEPING
DRINKING WATER DAILY
18. 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
NO
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
19. 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
20. 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
21. 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
NO
Y E S
66.4
33.6
TOILET FACILITY PRESENT IN THE HOUSE
22. 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 OILE T S NOT P RE S E NT
T OILE T S NOT P ROP E RLY C ONS T RUC T E D
OLD NORMS
MORE C OMF ORT A BLE
F E E L S UF F OC A T E D IN T OILE T S
36
16
66
54
45
REASON FOR GOING FOR OPEN DEFECATION
23. 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 OILE T S NOT P ROP E RLY C ONS T RUC T E D
T OILE T S A RE UNH Y GIE NIC
F E E L LE S S C OMF ORT A BLE
F E E L S UF F OC A T E D IN T OILE T S
CHART TITLE
21.8
78.2
Y E S
NO
SHOULD WOMEN GO FOR OPEN DEFECATION
18.9
46.3
9
28.5
IT IS S A F E F OR T H E M
T H E Y DO NOT H A VE A NY OP T ION
IT IS MORE H Y GIE NIC
IT IS NOT S A F E
PERCEPTION ABOUT WOMEN GOING FOR
OPEN DEFECATION
24. 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
NO
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
25. 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)
26. 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
27. 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.
28. 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
29. 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:
30. 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
31. 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
32. 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
33. 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
