title: Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India.
abstract: A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, GA marieke.heijnen@gmail.com.
authors.forename: Marieke
authors.initials: M
authors.lastname: Heijnen
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Parimita
authors.initials: P
authors.lastname: Routray
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Belen
authors.initials: B
authors.lastname: Torondel
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
mesh_terms: D003430:Cross-Sectional Studies; D003625:Data Collection; D003672:Defecation; D005191:Family Characteristics; D005260:Female; D006801:Humans; D006920:Hygiene; D007194:India; D008297:Male; D010865:Pilot Projects; D011204:Poverty Areas; D012499:Sanitation / Q000592:standards*; D011795:Surveys and Questionnaires; D014038:Toilet Facilities / Q000592:standards*; D014505:Urban Population