A Geospatial Analysis of Community Sanitation Infrastructure on Child Health Outcomes Open Access

Korona, Jessica Anne (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/2z10wr06s?locale=en



A Geospatial Analysis of Community Sanitation Infrastructure and Child Health Outcomes


Jessica Anne Korona

Background : An estimated 2.4 billion people lack access to improved sanitation facilities. 60% of those practicing open defecation reside in India. The Millennium Development Goals made progress, however, as of 2015 less than 50% of India's population has access to improved sanitation. While sanitation coverage is believed to be protective against child disease, high levels of community coverage may be necessary to realize health gains. This can be explored through spatial analysis of community sanitation coverage and child disease.

Methods : This is a secondary analysis of geospatial data from households in 45 intervention villages in a matched-cohort study designed to assess the effectiveness of combined community-level water and sanitation intervention implemented by Gram Vikas. Clusters of high coverage improved sanitation coverage and low coverage unimproved sanitation coverage were calculated using Bernoulli's spatial scan statistic in SaTScan at distances of 250, 500, 750, and 1000 meters. Binary variables were created to designate presence in a cluster of improved sanitation at each distance. This exposure was used to model diarrhea, child stunting, underweight, and continuous HAZ and WAZ in multivariate logistic and linear regression adjusting for random effects of clustering.

Results : Presence in a cluster of improved sanitation coverage at 500m was protective against child stunting (OR=0.83, 95%CI:0.73-0.94). This relationship remained the same when adjusting for child's sex and age, but decreased when adjusting for household caste and wealth quintiles (OR=0.91, 95%CI:0.91-1.02). The effect was the similar for child underweight. A significant relationship was determined between presence in a cluster of improved sanitation and height and weight for age z-scores (HAZ, WAZ). When present in a cluster, there is a 0.32 increase in HAZ adjusting for child's sex, age, household caste, and wealth quintile (p=0.0154). The effect is a 0.38 increase looking at WAZ (p=0.0003).

Conclusion : This study illuminates the importance of achieving community level sanitation in rural India. Residing in a cluster of improved sanitation is protective for HAZ and WAZ. Future research and sanitation programs should work to promote 100% sanitation coverage and use in communities, consistent with the Sustainable Development Goals.

Table of Contents

Table of Contents

I. Literature Review

a. Global Sanitation 1

b. Disease Burden 2

c. Transmission Pathways 4

d. Open defecation 5

e. Latrine use and other routes of exposure 6

f. Evidence for health benefits 7

g. Community coverage and use 9

h. Indian Government sanitation initiatives 11

i. Gram Vikas, MANTRA 13

j. Spatial analyses in WASH 14

II. Research Goals, Rational, and Aims

a. Research Goal 17

b. Rationale 17

c. Research Aims 18

III. Methods

a. Study population 19

b. Sanitation variables and covariate data 19

c. Diarrheal disease 20

d. Anthropometry 20

e. Statistical Analyses 20

IV. Results

a. Sample characteristics 24

b. Sanitation infrastructure 26

c. Child outcomes 29

d. Disease models 29

V. Discussion 41

a. Strengths and Limitations 43

VI. Conclusions & Recommendations 45

VII. References 46

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