title: Neighbour-shared versus communal latrines in urban slums: a cross-sectional study in Orissa, India exploring household demographics, accessibility, privacy, use and cleanliness.
abstract: BACKGROUND
  A growing proportion of the global population rely on shared sanitation facilities, despite their association with adverse health outcomes. We sought to explore differences between neighbour-shared and communal latrines in terms household demographics, accessibility, facilities and use.
  
  
  METHODS
  We conducted surveys among 295 households relying on shared sanitation in 30 slums in Orissa, India, 60.3% (178) of which relied on neighbour-shared latrines while the balance relied on communal latrines. We collected household demographic data, conducted latrine spot-checks and collected data on indicators of use, accessibility, privacy and cleanliness.
  
  
  RESULTS
  Compared to neighbour-shared facilities, households relying on communal facilities were poorer, larger, less educated, less likely to have access to piped water and more likely to have a member practicing open defecation. Communal latrines were also less accessible, less likely to have water or a hand washing station on site and cleaned less frequently; they were more likely to have visible faeces and flies present.
  
  
  CONCLUSIONS
  We found significant differences between neighbour-shared and communal facilities in terms of user demographics, access, facilities and cleanliness that could potentially explain differences in health. These findings highlight the need for a shared sanitation policy that focuses not just on the number of users, but also on maintenance, accessibility, cleanliness and provision of water and hand washing facilities.
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK Marieke.Heijnen@gmail.com.
authors.forename: Marieke
authors.initials: M
authors.lastname: Heijnen
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Parimita
authors.initials: P
authors.lastname: Routray
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Belen
authors.initials: B
authors.lastname: Torondel
authors.affiliation: Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
mesh_terms: D003140:Communicable Disease Control / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D005191:Family Characteristics; D005260:Female; D063373:Hand Hygiene / Q000592:standards*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010272:Parasitic Diseases / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D011204:Poverty Areas; D018907:Privacy; D011634:Public Health; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012499:Sanitation / Q000592:standards; D014038:Toilet Facilities / Q000592:standards*
keywords: Environmental health; India; Public health; Shared sanitation; Toilet facilities; Vulnerable populations