1921
Volume 95, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability of methods to assess latrine use is uncertain. We assessed the reliability of reported use, the standard method, by comparing survey-based responses against passive latrine use monitors (PLUMs) through a cross-sectional study among 292 households in 25 villages in rural Odisha, India, which recently received individual household latrines under the TSC. PLUMs were installed for 2 weeks and householders responded to surveys about their latrine use behavior. Reported use was compared with PLUM results using Bland–Altman (BA) plots and concordance statistics. Reported use was higher than corresponding PLUM-recorded events across the range of comparisons. The mean reported “usual” daily events per household (7.09, 95% confidence interval [CI] = 6.51, 7.68) was nearly twice that of the PLUM-recorded daily average (3.62, 95% CI = 3.29, 3.94). There was poor agreement between “usual” daily latrine use and the average daily PLUM-recorded events (ρ = 0.331, 95% CI = 0.242, 0.427). Moderate agreement (ρ = 0.598, 95% CI = 0.497, 0.683) was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Reported latrine use, though already suggesting suboptimal adoption, likely exaggerates the actual level of uptake of latrines constructed under the program. Where reliance on self-reports is used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about “usual” latrine use behavior.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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2016-09-07
2017-11-18
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References

  1. Prüss-Ustün A, Bartram J, Clasen T, Colford JM, Cumming O, Curtis V, Bonjour S, Dangour AD, De France J, Fewtrell L, , 2014. Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 19: 894905.[Crossref]
  2. Hutton G, , 2015. Benefits and Costs of the Water Sanitation and Hygiene Targets for the post-2015 Development Agenda. Post-2015 Consensus: Water and Sanitation Assessment. Lowell, MA: Copenhagen Consensus Center.
  3. Bartram J, Brocklehurst C, Fisher MB, Luyendijk R, Hossain R, Wardlaw T, Gordon B, , 2014. Global monitoring of water supply and sanitation: history, methods and future challenges. Int J Environ Res Public Health 11: 81378165.[Crossref]
  4. Planning Commission GoI, 2013. Evaluation Study on Total Sanitation Campaign. New Delhi, India: Planning Commission, Government of India.
  5. Coffey D, Gupta A, Hathi P, Khurana N, Spears D, Srivastav N, Vyas S, , 2014. Revealed preference for open defecation. Econ Polit Wkly 49: 43.
  6. Barnard S, Routray P, Majorin F, Peletz R, Boisson S, Sinha A, Clasen T, , 2013. Impact of Indian total sanitation campaign on latrine coverage and use: a cross-sectional study in Orissa three years following programme implementation. PLoS One 8: e71438.[Crossref]
  7. TARU, 2008. Impact Assessment of Nirmal Gram Puraskar Awarded Panchayats. New Delhi, India: UNICEF.
  8. Sanan D, Moulik SG, , 2007. Community-Led Total Sanitation in Rural Areas: An Approach that Works. New Delhi, India: Water and Sanitation Program—South Asia, The World Bank.
  9. National Sample Survey Office GoI, 2013. Key Indicators of Drinking Water, Sanitation, Hygiene and Housing Condition in India. New Delhi, India: Ministry of Statistics and Programme Implementation, Government of India.
  10. Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM, Jr Gertler PJ, , 2014. The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. PLoS Med 11: e1001709.[Crossref]
  11. Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, Ensink J, Freeman M, Jenkins M, Odagiri M, Ray S, Sinha A, Suar M, Schmidt W-P, , 2014. Effectiveness of a rural sanitation programme on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health 2: e645e653.[Crossref]
  12. Arnold BF, Khush RS, Ramaswamy P, London AG, Rajkumar P, Ramaprabha P, Durairaj N, Hubbard AE, Balakrishnan K, Colford JMJ, , 2010. Causal inference methods to study non-randomized, pre-existing development interventions. Proc Natl Acad Sci USA 107: 2260522610.[Crossref]
  13. WSP, 2013. Linking Service Delivery Processes and Outcomes in Rural Sanitation: Findings from 56 Districts in India. New Delhi, India: Water and Sanitation Program, World Bank.
  14. Clasen T, Fabini D, Boisson S, Taneja J, Song J, Aichinger E, Bui A, Dadashi S, Schmidt WP, Burt Z, Nelson KL, , 2012. Making sanitation count: developing and testing a device for assessing latrine use in low-income settings. Environ Sci Technol 46: 32953303.[Crossref]
  15. Montgomery MA, Desai MM, Elimelech M, , 2010. Assessment of latrine use and quality and association with risk of trachoma in rural Tanzania. Trans R Soc Trop Med Hyg 104: 283289.[Crossref]
  16. O'Loughlin R, Fentie G, Flannery B, Emerson PM, , 2006. Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters. Trop Med Int Health 11: 14061415.[Crossref]
  17. Arnold BF, Khush RS, Ramaswamy P, Rajkumar P, Durairaj N, Ramaprabha P, Balakrishnan K, Colford JM, , 2015. Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies. Am J Trop Med Hyg 92: 159162.[Crossref]
  18. Larson E, Silberger M, Jakob K, Whittier S, Lai L, Della Latta P, Saiman L, , 2000. Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart and Lung 29: 136142.[Crossref]
  19. Larson EL, Aiello AE, Cimiotti JP, , 2004. Assessing nurses' hand hygiene practices by direct observation or self-report. J Nurs Meas 12: 7787.[Crossref]
  20. Harris A, Samore M, Nafziger R, DiRosario K, Roghmann M, Carmeli Y, , 2000. A survey on handwashing practices and opinions of healthcare workers. J Hosp Infect 45: 318321.[Crossref]
  21. Banda K, Sarkar R, Gopal S, Govindarajan J, Harijan BB, Jeyakumar MB, Mitta P, Sadanala ME, Selwyn T, Suresh CR, Thomas VA, Devadason P, Kumar R, Selvapandian D, Kang G, Balraj V, , 2007. Water handling, sanitation and defecation practices in rural southern India: a knowledge, attitudes and practices study. Trans R Soc Trop Med Hyg 101: 11241130.[Crossref]
  22. WHO UNICEF, 2006. Core Questions on Drinking Water and Sanitation for Household Surveys. Geneva, Switzerland: WHO, UNICEF.
  23. Biran A, Schmidt WP, Wright R, Jones T, Seshadri M, Isaac P, Nathan N, Hall P, McKenna J, Granger S, , 2009. The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial. Trop Med Int Health 14: 13031314.[Crossref]
  24. Schmidt W-P, Cairncross S, , 2009. Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol 43: 986992.[Crossref]
  25. Scott BE, Schmidt WP, Aunger R, Garbrah-Aidoo N, Animashaun R, , 2008. Marketing hygiene behaviours: the impact of different communication channels on reported handwashing behaviour of women in Ghana. Health Educ Res 23: 392401.[Crossref]
  26. Manun'Ebo M, Cousens S, Haggerty P, Kalengaie M, Ashworth A, Kirkwood B, , 1997. Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire. Trop Med Int Health 2: 10151021.[Crossref]
  27. Curtis V, Cousens S, Mertens T, Traore E, Kanki B, Diallo I, , 1993. Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility. Bull World Health Organ 71: 2332.
  28. Zwane AP, Zinman J, Van Dusen E, Pariente W, Null C, Miguel E, Kremer M, Karlan DS, Hornbeck R, Giné X, , 2011. Being surveyed can change later behavior and related parameter estimates. Proc Natl Acad Sci USA 108: 18211826.[Crossref]
  29. Clasen T, Boisson S, Routray P, Cumming O, Jenkins M, Ensink JH, Bell M, Freeman MC, Peppin S, Schmidt W-P, , 2012. The effect of improved rural sanitation on diarrhoea and helminth infection: design of a cluster-randomized trial in Orissa, India. Emerg Themes Epidemiol 9: 7.[Crossref]
  30. Boisson S, Sosai P, Ray S, Routray P, Torondel B, Schmidt W-P, Bhanja B, Clasen T, , 2014. Promoting latrine construction and use in rural villages practicing open defecation: process evaluation in connection with a randomised controlled trial in Orissa, India. BMC Res Notes 7: 486.[Crossref]
  31. Press S, , 2011. Stata Survey Data Reference Manual, Release 12. College Station, TX: StataCorp LP.
  32. RC Team, 2014. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.
  33. Bland JM, Altman DG, , 1999. Measuring agreement in method comparison studies. Stat Methods Med Res 8: 135160.[Crossref]
  34. Carstensen B, , 2010. Comparing methods of measurement: extending the LoA by regression. Stat Med 29: 401410.[Crossref]
  35. Steichen TJ, Cox NJ, , 2002. A note on the concordance correlation coefficient. Stata J 2: 183189.
  36. Crawford SB, Kosinski AS, Lin H-M, Williamson JM, Barnhart HX, , 2007. Computer programs for the concordance correlation coefficient. Comput Methods Programs Biomed 88: 6274.[Crossref]
  37. Chitty A, Ensink J, EstevesMills J, Majorin F, , 2015. Estimating the Potential Impact of Sanitary Child Stool Disposal. London: SHARE, London School of Hygiene and Tropical Medicine.
  38. Gil A, Lanata C, Kleinau E, Penny M, , 2004. Strategic Report 11: Children's Feces Disposal Practices in Developing Countries and Interventions to Prevent Diarrheal Diseases: A Literature Review. La Molina, Peru: Instituto de Investigacion Nutricional.
  39. O'Reilly K, Louis E, Thomas E, Sinha A, , 2015. Combining sensor monitoring and ethnography to evaluate household latrine usage in rural India. J Water Sanit Hyg Dev 5: 426438.[Crossref]
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Supplementary Data

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  • Received : 10 Feb 2016
  • Accepted : 31 May 2016

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