Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2013 Aug 21;8(8):e71438. doi: 10.1371/journal.pone.0071438. eCollection 2013.
Faced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. In settings like rural India where open defecation is common, this may result in sub-optimal compliance (use), thereby continuing to leave the population exposed to human excreta.
We conducted a cross-sectional study to investigate latrine coverage and use among 20 villages (447 households, 1933 individuals) in Orissa, India where the Government of India's Total Sanitation Campaign had been implemented at least three years previously. We defined coverage as the proportion of households that had a latrine; for use we identified the proportion of households with at least one reported user and among those, the extent of reported use by each member of the household.
Mean latrine coverage among the villages was 72% (compared to <10% in comparable villages in the same district where the Total Sanitation Campaign had not yet been implemented), though three of the villages had less than 50% coverage. Among these households with latrines, more than a third (39%) were not being used by any member of the household. Well over a third (37%) of the members of households with latrines reported never defecating in their latrines. Less than half (47%) of the members of such households reported using their latrines at all times for defecation. Combined with the 28% of households that did not have latrines, it appears that most defecation events in these communities are still practiced in the open.
A large-scale campaign to implement sanitation has achieved substantial gains in latrine coverage in this population. Nevertheless, gaps in coverage and widespread continuation of open defecation will result in continued exposure to human excreta, reducing the potential for health gains.
面对在实现卫生目标方面的巨大差距，一些政府实施了使用厕所建设补贴的运动，以克服收入限制，快速扩大覆盖面。在像印度农村这样随地大小便很常见的地方，这可能导致合规性（使用）不理想，从而继续使人们暴露在人类粪便中。
我们在印度奥里萨邦进行了一项横断面研究，调查了在 Total Sanitation Campaign 至少实施了三年的 20 个村庄（447 户，1933 人）的厕所覆盖和使用情况。我们将覆盖率定义为拥有厕所的家庭比例；对于使用，我们确定了至少有一个报告使用者的家庭比例，在这些家庭中，每个家庭成员的报告使用程度。
村庄的平均厕所覆盖率为 72%（而在同一地区没有实施 Total Sanitation Campaign 的可比村庄中，覆盖率不到 10%），尽管有三个村庄的覆盖率低于 50%。在这些有厕所的家庭中，超过三分之一（39%）没有任何家庭成员使用。超过三分之一（37%）有厕所的家庭报告说他们从不在家里的厕所排便。不到一半（47%）的有厕所的家庭成员报告说他们一直都在使用厕所排便。加上 28%没有厕所的家庭，这些社区的大多数排便事件似乎仍在户外进行。
一项大规模的卫生运动在该人群中实现了厕所覆盖的大幅增长。然而，覆盖范围的差距和广泛持续的露天排便将导致持续接触人类粪便，降低健康收益的潜力。
