Department of Geography, Malda College, Malda, West Bengal, India.
Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
BMJ Open. 2023 Jul 5;13(7):e072507. doi: 10.1136/bmjopen-2023-072507.
The study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India.
The present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019-2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots.
The study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India.
The outcome measure was the prevalence of OD.
The prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural-urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%).
The practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.
本研究对印度随地大小便（OD）的空间异质性及其相关驱动因素进行了背景分析。
本研究涉及 2019-2021 年期间在印度进行的第五轮全国家庭健康调查的二次横断面调查数据。我们使用 LISA 聚类技术绘制了 OD 实践的空间异质性，并使用多元回归模型评估了 OD 的关键驱动因素。Fairlie 分解模型用于确定导致 OD 热点和冷点形成的因素。
本研究在印度进行，包括印度 36 个邦和联邦属地的 636699 个抽样家庭，涵盖了印度 707 个地区。
结果测量是 OD 的流行率。
OD 的流行率接近 20%，热点主要集中在该国中北部地区。农村-城市（26%对 6%）、文盲-受过高等教育（32%对 4%）和贫困-富裕（52%对 2%）之间的差距非常大。与农村地区和没有供水服务的家庭相比，农村地区和没有供水服务的家庭的 OD 几率高 2.7 倍和 1.9 倍。空间误差模型确定，文盲家庭（系数=0.50，p=0.001）是 OD 的主要空间关联预测因素，其次是最贫穷的家庭（系数=0.31，p=0.001）和印度教徒（系数=0.10，p=0.001）。OD 的高-高和低-低集群不平等为 38%，发现家庭财富五分位数（67%）是最重要的贡献因素，其次是宗教（22.8%）和教育水平（6%）。
OD 实践集中在印度中北部地区，特别是在贫困、文盲和社会落后群体中。应采取政策措施，通过采用多光谱和多部门方法，改善卫生设施做法，特别是在重点地区和弱势群体中。
