title: Water handling, sanitation and defecation practices in rural southern India: a knowledge, attitudes and practices study.
abstract: Diarrhoea and water-borne diseases are leading causes of mortality in developing countries. To understand the socio-cultural factors impacting on water safety, we documented knowledge, attitudes and practices of water handling and usage, sanitation and defecation in rural Tamilnadu, India, using questionnaires and focus group discussions, in a village divided into an upper caste Main village and a lower caste Harijan colony. Our survey showed that all households stored drinking water in wide-mouthed containers. The quantity of water supplied was less in the Harijan colony, than in the Main village (P<0.001). Residents did not associate unsafe water with diarrhoea, attributing it to 'heat', spicy food, ingesting hair, mud or mosquitoes. Among 97 households interviewed, 30 (30.9%) had toilets but only 25 (83.3%) used them. Seventy-two (74.2%) of respondents defecated in fields, and there was no stigma associated with this traditional practice. Hand washing with soap after defecation and before meals was common only in children under 15 years (86.4%). After adjusting for other factors, perception of quantity of water received (P<0.001), stated causation of diarrhoea (P=0.02) and low socio-economic status (P<0.001) were significantly different between the Main village and the Harijan colony. Traditional practices may pose a significant challenge to programmes aimed at toilet usage and better sanitation.
authors.affiliation: Christian Medical College, Vellore, India.
authors.forename: Kalyan
authors.initials: K
authors.lastname: Banda
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarkar
authors.forename: Srila
authors.initials: S
authors.lastname: Gopal
authors.forename: Jeyanthi
authors.initials: J
authors.lastname: Govindarajan
authors.forename: Bhim Bahadur
authors.initials: BB
authors.lastname: Harijan
authors.forename: Mary Benita
authors.initials: MB
authors.lastname: Jeyakumar
authors.forename: Philip
authors.initials: P
authors.lastname: Mitta
authors.forename: Madhuri Evangeline
authors.initials: ME
authors.lastname: Sadanala
authors.forename: Tryphena
authors.initials: T
authors.lastname: Selwyn
authors.forename: Christina Rachel
authors.initials: CR
authors.lastname: Suresh
authors.forename: Verghese Anjilivelil
authors.initials: VA
authors.lastname: Thomas
authors.forename: Pethuru
authors.initials: P
authors.lastname: Devadason
authors.forename: Ranjit
authors.initials: R
authors.lastname: Kumar
authors.forename: David
authors.initials: D
authors.lastname: Selvapandian
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.forename: Vinohar
authors.initials: V
authors.lastname: Balraj
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003672:Defecation; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health; D012499:Sanitation / Q000592:standards*; D014881:Water Supply / Q000592:standards