Shared Sanitation and the Prevalence of Diarrhea in Young Children: Evidence from 51 Countries, 2001–2011

James A. Fuller Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom

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Thomas Clasen Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom

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Marieke Heijnen Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom

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Joseph N. S. Eisenberg Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom

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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.

Author Notes

* Address correspondence to James A. Fuller, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48103. E-mail: jafuller@umich.edu

Financial support: This study was supported by the National Institutes of Health (grant R01-AI050038).

Disclosure: None of the authors have any competing financial interests.

Authors' addresses: James A. Fuller and Joseph N. S. Eisenberg, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, E-mails: jafuller@umich.edu and jnse@umich.edu. Thomas Clasen and Marieke Heijnen, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: thomas.clasen@lshtm.ac.uk and marieke.heijnen@lshtm.ac.uk.

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