Volume 91, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Shared sanitation is defined as unimproved because of concerns that it creates unsanitary conditions; this policy is being reconsidered. We assessed whether sharing a toilet facility was associated with an increased prevalence of diarrhea among children < 5 years of age. We use data from Demographic and Health Surveys conducted in 51 countries. Crude and adjusted prevalence ratios (PRs) for diarrhea, comparing children from households that used a shared facility with children from households that used a non-shared facility, were estimated for each country and pooled across countries. Unadjusted PRs varied across countries, ranging from 2.15 to 0.65. The pooled PR was 1.09; differences in socioeconomic status explained approximately half of this increased prevalence (adjusted PR = 1.05). Shared sanitation appears to be a risk factor for diarrhea although differences in socioeconomic status are important. The heterogeneity across countries, however, suggests that the social and economic context is an important factor.


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  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, Child Health Epidemiology Reference Group of WHO and UNICEF; , 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref] [Google Scholar]
  2. World Health Organization. Global Health Observatory Data Repository, 2013. Available at: http://apps.who.int/gho/data/node.country. Accessed July 12, 2013. [Google Scholar]
  3. UNICEF and World Health Organization, 2012. Progress on Drinking Water and Sanitation: 2012 Update. Geneva: World Health Organization. [Google Scholar]
  4. UNICEF and World Health Organization, 2012. Post-2015 Proposal for Sanitation Targets and Indicators. Geneva: World Health Organization. [Google Scholar]
  5. Schouten MA, Mathenge RW, , 2010. Communal sanitation alternatives for slums: a case study of Kibera, Kenya. Phys Chem Earth 35: 815822.[Crossref] [Google Scholar]
  6. Wegelin-Schuringa M, Kodo T, , 1997. Tenancy and sanitation provision in informal settelements in Nairobi: revisiting the public latrine option. Environ Urban 9: 181190.[Crossref] [Google Scholar]
  7. Nelson KL, Murray A, , 2008. Sanitation for unserved populations: technologies, implementation challenges, and opportunities. Annu Rev Environ Resour 33: 119151.[Crossref] [Google Scholar]
  8. Heijnen M, Cumming O, Peletz R, Chan GKS, Brown J, Baker K, Clasen T, , 2014. Shared sanitation versus individual household latrines: a systematic review of health outcomes. PLoS ONE 9: e93300. Published April 17, 2014, doi:10.1371/journal.pone.0093300.[Crossref] [Google Scholar]
  9. Baker KK, O'Rielly CE, Mintz ED, Farag T, Nasrin D, Panchalingham S, Blackwelder W, Wu Y, Nataro JP, Kotloff KL, Alonso P, Breiman RF, Sur D, Faruque ASG, Zaidi A, Saha D, Sow SO, Levine MM, , 2011. The risk of moderate and severe diarrhea in children less than five years old is increased among families who share a sanitation facility. Paper presented at the 60th Annual Meeting of the American Society of Tropical Medicine and Hygiene, December 4–8, Philadelphia, PA, United States. [Google Scholar]
  10. Khan MU, , 1987. Limitation of communal latrines in changing the prevalence of parasites and diarrhoeal attack rate in Dhaka peri-urban slums. Environ Pollut 47: 187194.[Crossref] [Google Scholar]
  11. Chakraborty AK, Das JC, , 1983. Comparative study of incidence of diarrhea among children in two different environmental situations in Calcutta. Indian Pediatr 20: 907913. [Google Scholar]
  12. Brooks JT, Shapiro RL, Kumar L, Wells JG, Phillips-Howard PA, Shi YP, Vulule JM, Hoekstra RM, Mintz E, Slutsker L, , 2003. Epidemiology of sporadic bloody diarrhea in rural western Kenya. Am J Trop Med Hyg 68: 671677. [Google Scholar]
  13. Shultz A, Omollo JO, Burke H, Qassim M, Ochieng JB, Weinberg M, Feiken DR, Breiman RF, , 2009. Cholera outbreak in Kenyan refugee camp: risk factors for illness and importance of sanitation. Am J Trop Med Hyg 80: 640645. [Google Scholar]
  14. Sobel J, Gomes TA, Ramos RT, Hoekstra M, Rodrigue D, Rassi V, Griffin PM, , 2004. Pathogen-specific risk factors and protective factors for acute diarrheal illness in children aged 12–59 months in Sao Paulo, Brazil. Clin Infect Dis 38: 15451551.[Crossref] [Google Scholar]
  15. Ghosh S, Sengupta PG, Mandal SK, Manna B, Sikder SN, Sirkar BK, , 1994. Maternal behaviour and feeding practices as determinants of childhood diarrhoea: Some observations amongst rural Bengalese mothers. Indian J Public Health 38: 7780. [Google Scholar]
  16. Tuttle J, Ries AA, Chimba RM, Perera CU, Bean NH, Griffin PM, , 1995. Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission. J Infect Dis 171: 371375.[Crossref] [Google Scholar]
  17. Whittington D, Jeuland M, Barker K, Yuen Y, , 2012. Setting priorities, targeting subsidies among water, sanitation, and preventive health interventions in developing countries. World Dev 40: 15461568.[Crossref] [Google Scholar]
  18. Blakely T, Hales S, Kieft C, Wilson N, Woodward A, , 2005. The global distribution of risk factors by poverty level. Bull World Health Organ 83: 118126. [Google Scholar]
  19. Isunju JB, Schwartz K, Schouten MA, Johnson WP, van Dijk MP, , 2011. Socio-economic aspects of improved sanitation in slums: a review. Public Health 125: 368376.[Crossref] [Google Scholar]
  20. Katukiza AY, Ronteltap M, Oleja A, Niwagaba CB, Kansiime F, Lens PN, , 2010. Selection of sustainable sanitation technologies for urban slums: a case of Bwaise III in Kampala, Uganda. Sci Total Environ 409: 5262.[Crossref] [Google Scholar]
  21. Kulabako RN, Nalubega M, Wozei E, Thunvik R, , 2010. Environmental health practices, constraints and possible interventions in peri-urban settlements in developing countries: a review of Kampala, Uganda. Int J Environ Health Res 20: 231257.[Crossref] [Google Scholar]
  22. Ramakrishnan R, Venkatarao T, Koya PK, Kamaraj P, , 1999. Influence of recall period on estimates of diarrhoea morbidity in infants in rural Tamilnadu. Indian J Public Health 43: 136139. [Google Scholar]
  23. Feikin DR, Audi A, Olack B, Bigogo GM, Polyak C, Burke H, Williamson J, Breiman RF, , 2010. Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya. Int J Epidemiol 39: 450458.[Crossref] [Google Scholar]
  24. Zafar SN, Luby SP, Mendoza C, , 2010. Recall errors in a weekly survey of diarrhoea in Guatemala: determining the optimal length of recall. Epidemiol Infect 138: 264269.[Crossref] [Google Scholar]
  25. Arnold BF, Galiani S, Ram PK, Hubbard AE, Briceño B, Gertler PJ, Colford JM, Jr, 2013. Optimal recall period for caregiver-reported illness in risk factor and intervention studies: a multicountry study. Am J Epidemiol 177: 361370.[Crossref] [Google Scholar]

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  • Received : 30 Aug 2013
  • Accepted : 17 Mar 2014
  • Published online : 02 Jul 2014

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