title: Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001-2011.
abstract: Shared sanitation is defined as unimproved because of concerns that it creates unsanitary conditions; this policy is being reconsidered. We assessed whether sharing a toilet facility was associated with an increased prevalence of diarrhea among children < 5 years of age. We use data from Demographic and Health Surveys conducted in 51 countries. Crude and adjusted prevalence ratios (PRs) for diarrhea, comparing children from households that used a shared facility with children from households that used a non-shared facility, were estimated for each country and pooled across countries. Unadjusted PRs varied across countries, ranging from 2.15 to 0.65. The pooled PR was 1.09; differences in socioeconomic status explained approximately half of this increased prevalence (adjusted PR = 1.05). Shared sanitation appears to be a risk factor for diarrhea although differences in socioeconomic status are important. The heterogeneity across countries, however, suggests that the social and economic context is an important factor.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom jafuller@umich.edu.
authors.forename: James A
authors.initials: JA
authors.lastname: Fuller
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Marieke
authors.initials: M
authors.lastname: Heijnen
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Joseph N S
authors.initials: JN
authors.lastname: Eisenberg
mesh_terms: D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012499:Sanitation / Q000379:methods; D012923:Social Class; D014038:Toilet Facilities / Q000145:classification* / Q000191:economics