Dwivedi Laxmi Kant, Banerjee Kajori, Jain Nidhi, Ranjan Mukesh, Dixit Priyanka
International Institute for Population Sciences, Mumbai, India.
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
SSM Popul Health. 2018 Oct 31;7:013-13. doi: 10.1016/j.ssmph.2018.10.013. eCollection 2019 Apr.
Despite threefold increase in investment (from Rs. 28,500 million to Rs. 90,000 million during 2014-17) in the allocation of funds for the Clean India movement, creating awareness and various social movements, more than half of the rural population (52.1%) of the country still defecates in the open. This study aims to examine the prevalence of improved sanitation facilities and safe stool disposal in India and its states. It also aims to further establish inter-linkages between safe stool disposal and child health.
The present study uses data from the fourth round of the recently conducted cross-sectional National Family Health Survey (NFHS-4, 2015-16).
Two proxy indicators used to assess the effect on child health are: stunting and mortality of children under the age of five years. Multivariate logistic regression analysis was employed to examine the impact of improved sanitation facilities and safe stool disposal on child health measured by height-for-age as a dichotomous variable. Multivariate discrete-time logistic model was used to examine the impact of improved sanitation facilities and safe stool disposal on under-five child deaths.
The results reveal that unsafe disposal of stools are one of the main contributing factors responsible for stunting and under-five mortality among children. The prevalence was clearly seen to be higher in households where open defecation and unsafe stool disposal were practised.
The central behavioural change to be brought about among the people is to improve the cleanliness levels of the neighbourhood and help children spend their childhood free from the misery of malnourishment or in the worst case, death. It is not an impossible task for a country that houses the cleanest village in Asia, Mawlynnong in the Northeast state of Meghalaya, India. If one state could do it, it could be replicated in other states too.
尽管在为“清洁印度”运动、提高意识及各种社会运动分配资金方面的投资增长了两倍（从2014年至2017年期间的285亿卢比增至900亿卢比），但该国仍有超过一半（52.1%）的农村人口露天排便。本研究旨在调查印度及其各邦改善卫生设施和安全粪便处理的普及率。它还旨在进一步建立安全粪便处理与儿童健康之间的相互联系。
本研究使用了最近进行的第四轮全国家庭健康调查（NFHS - 4，2015 - 2016年）的横断面数据。
用于评估对儿童健康影响的两个替代指标是：五岁以下儿童的发育迟缓率和死亡率。采用多变量逻辑回归分析来检验改善卫生设施和安全粪便处理对以年龄别身高作为二分变量衡量的儿童健康的影响。使用多变量离散时间逻辑模型来检验改善卫生设施和安全粪便处理对五岁以下儿童死亡的影响。
结果显示，不安全的粪便处理是导致儿童发育迟缓和五岁以下儿童死亡的主要因素之一。在实行露天排便和不安全粪便处理的家庭中，这种情况的发生率明显更高。
需要促使人们实现的核心行为改变是提高社区的清洁水平，帮助儿童度过没有营养不良痛苦的童年，最坏的情况是避免死亡。对于一个拥有亚洲最清洁村庄——印度东北部梅加拉亚邦的马乌林农的国家来说，这并非不可能完成的任务。如果一个邦能够做到，那么其他邦也可以效仿。
