By Kundan Pandey Down to Earth, Sep 23, 2013
Research
finds 10 per cent increase in open defecation associated with a 0.7 per cent
increase in stunting in 112 districts
Poor
sanitation gives arise to a number of health problems, but now research shows
that it is linked to stunted growth as well. A research published last week in
journal PloS One has concluded that lack of sanitation is a
potential contributor to stunting in the country.
The study
was carried out by Dean Spears from the Centre for Development Economics at the
Delhi School of Economics along with Arabinda Ghosh, an Indian Administrative
Service official, and Oliver Cumming of the London School of Hygiene and Tropical
Medicine. The researchers found that a 10 per cent increase in open defecation
was associated with a 0.7 per cent increase in both stunting and severe
stunting.
The
researchers used recently published data on levels of stunting in 112 districts
of India to explore the relationship between open defecation and stunting
within the population in these districts. They used information from the 2011 HUNGaMA (hunger and malnutrition)
survey for stunting data and 2011 Indian Census for the same
districts was referred to for other indicators like open defecation. The
HUNGaMA survey is the most recent large-scale data on malnutrition which
evaluated 109,093 children under five years of age in 73,670 households.
The
researchers carried out a statistical analysis after adjusting potential
confounding factors such as socio-economic status, maternal education and
calorie availability. They found that stunting figure of the districts where
people defecate in the open is higher. In general, children in these districts
were found unhealthy. “Over half of the children are stunted, and almost a
third of children are severely stunted. The early-life disease environment is
poor: over 70 per cent of households defecate in the open and 71 out of every
1,000 babies born alive die before they are one year old. Two-thirds of all
adults, and slightly more than half of females, are reported as literate in the
Census,” the research findings state.
Population
density's compounding effect
The
finding calls for immediate attention of and follow up by policy makers in
India. Open defecation is a pressing problem because it is much more common in
India than in many poor African countries. UNICEF and the WHO estimate that in
2010, 25 per cent of people in sub-Saharan Africa defecated in the open. Recent
health surveys in the largest three sub-Saharan countries show that 31.1 per
cent households in Nigeria, 38.3 households in Ethiopia, and 12. 1 per cent
households in the Democratic Republic of the Congo defecate in the open.
Consider the comparative data for India. The Planning Commission report on
Evaluation Study on Total Sanitation Campaign, 2013, suggests that around 72.63
per cent of rural India still defecates in the open.
What's
more worrying for India is that density of population in the country is very
high which has the potential to compound the problem.
Spears
has written on the subject in a research paper prepared for Public Health
Foundation of India (PHFI) on February 15 this year. “If open defecation is
indeed keeping children from growing to their genetic potentials–rather than
merely being coincidentally correlated with height–we would expect open
defecation to be more important for health outcomes where children are more
likely to encounter whatever fecal germs are introduced into the environment.
This means that population density should matter: living near neighbours who
defecate in the open is more threatening than living in the same country as
people who defecate in the open far away.”
He goes
on to say that Indian children face the double threat of widespread open
defecation and high population density, and that stunting among Indian
children is no surprise. He stresses on proper efforts to motivate people
to not only construct latrines but use them as well.
However,
motivation and awareness have not received sufficient attention in the planning
of the government. The Planning Commission evaluation report of Total
Sanitation Campaign report points out that the practice of open
defecation was supposed to be stopped with all individual households being
given access to the toilets by 2012; toilet facilities to all schools and
anganwadi centres were to be provided by 2009 and Community Sanitary
Complex/Women Sanitary Complex were to be provided in case of lack of space or
financial constraints. Government of India gives Nirmal Gram Puraskar to push
the sanitation campaign. But there is no significant progress as 72 per cent
people in rural India still defecate in the open.
