Department of Economics, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology, Islamabad, H-12, Pakistan.
Environ Sci Pollut Res Int. 2021 Aug;28(29):38749-38763. doi: 10.1007/s11356-021-13492-7. Epub 2021 Mar 19.
While the state of sanitation in Pakistan has improved in the last decade, a significant proportion of its population is still using inadequate sanitation or no toilet facility at all. Open defecation has decreased over the years; however, it has been replaced by poor quality sanitation in rural areas that might still cause diarrhoea and undernutrition. The research regarding inadequate sanitation in Pakistan, especially in terms of the sanitation ladder, remains limited. The present research thus fills this research gap by assessing the impact of different types of sanitation on the prevalence of stunting and underweight (moderate as well as severe) among under-five children in Pakistan using the nationally representative micro survey, Pakistan Demographic and Health Survey (2017-18). The sanitation ladder comprises of piped to sewer (highest level, base) followed by flush to septic tank, flush to pit latrine, other improved, unimproved sanitation, and open defecation. In order to estimate the adjusted and unadjusted odds ratios of the determinants, this research uses logistic regressions are used to estimate adjusted and unadjusted odds ratios of the determinants. We show that toilets connected to piped sewerage network are rare in the rural areas of Pakistan and a large segment of the rural population is still practicing open defecation. The logistic regressions show that piped sewerage network and flush to septic tanks are associated with lowest odds (both adjusted and unadjusted) of stunting and underweight among under-five children. In multivariate regressions, pit latrines are associated with even higher adjusted odds of severe and moderate and severe stunting as well as underweight among under-five children, showing that poor quality pit latrines may bring the source of faecal contamination to the doorstep of the households. Therefore, interventions targeting reduction in open defecation should promote good quality toilets for sustainable long-term improvements in child health.
尽管巴基斯坦的卫生状况在过去十年中有所改善，但仍有相当一部分人口使用不充分的卫生设施或根本没有厕所。多年来，露天排便的情况有所减少；然而，农村地区的卫生条件较差，仍然可能导致腹泻和营养不良。关于巴基斯坦卫生设施不足的研究，特别是在卫生设施阶梯方面，仍然有限。因此，本研究通过使用全国代表性微观调查——巴基斯坦人口与健康调查（2017-18 年），评估不同类型卫生设施对巴基斯坦五岁以下儿童发育迟缓（包括中度和重度）和体重不足（中度和重度）的患病率的影响，填补了这一研究空白。卫生设施阶梯包括污水管到下水道（最高级别，基础），其次是冲洗到化粪池、冲洗到坑式厕所、其他改良卫生设施、非改良卫生设施和露天排便。为了估计决定因素的调整和未调整比值比，本研究使用逻辑回归来估计决定因素的调整和未调整比值比。我们发现，巴基斯坦农村地区很少有与污水管相连的厕所，很大一部分农村人口仍在露天排便。逻辑回归表明，污水管网和冲洗到化粪池与五岁以下儿童发育迟缓率和体重不足率最低（调整和未调整）有关。在多变量回归中，坑式厕所与五岁以下儿童严重和中度以及严重发育迟缓以及体重不足的调整后比值比更高，这表明质量较差的坑式厕所可能将粪便污染源带到了家庭门口。因此，旨在减少露天排便的干预措施应推广高质量的厕所，以实现儿童健康的可持续长期改善。
