Examining the linkage between open defecation and child malnutrition in India

https://doi.org/10.1016/j.childyouth.2020.105345Get rights and content

Highlights:

  • Open defecation is significantly associated with stunting and underweight among children.

  • The practice of open defecation is high in Jharkhand (71%) followed by Bihar (69%) and Odisha (66%).

  • The odds of being stunted is 14 percent higher among the children of those who defecate in open as compared to improved toilet users.

  • There is a need to develop institutional, community, and public sanitation services.

Abstract

Nutritional status of children is a key to track the development progress and a precursor to human well-being. It is not possible to realize sustainable development in the absence of nutritional well-being. One of the factors affecting nutritional status in developing countries is open defecation. India accounts for 90 percent of open defecation cases in South-Asia annually. Open defecation enables the absorption of fecal pathogens that leads to intestinal worms, diarrhoea, and environmental enteric malfunction. This leads to loss of appetite, lessening the body's immunity, disturbing the absorption of nutrients, and eventually leading to malnutrition. As there is not much scholarship on the relation between open defecation and malnutrition in the context of India, this study examines the linkages between open defecation and malnutrition among the under-five children in India. The examination is performed using data from the National Family Health Survey 2015–16, and assessing the nutritional status of children through stunting and underweight. The analysis clearly shows higher chances of being stunted and underweight with an increase in the prevalence of open defecation. Multivariate findings reveal that the chances of stunting and underweight are 13% and 28%, respectively, more among the population defecating in the open compared to those defecating in an improved toilet facility. Awareness and state’s financial help in improving sanitation facilities are keys to reducing the level of open defecation in India. A multi-sector approach should be adopted to overcome the challenges of malnutrition resulting through open defecation.

Section snippets

Introduction:

It is not possible to realize sustainable development in the absence of nutritional well-being. Achieving key global health objectives, for example, ending avoidable maternal and child deaths, will also require targeting malnutrition (WHO, 2016). Malnutrition is a significant public health issue resulting due to complicated pathophysiological mechanisms, making it dismal through socio-economic consequences, especially in the developing world (Verma et al., 2016). Malnutrition results in many

Data

The data for this study is taken from the fourth round of the National Family Health Survey (NFHS-4) conducted during 2015–16. This survey is the fourth in the series of national surveys; earlier, NFHS surveys were carried out in 1992-93 (NFHS-1), 1998-99 (NFHS-2) 2005-06 (NFHS-3). This survey is nationally representative and covers more than 99% population of India. NFHS is the Indian form of the Demographic Health Survey (DHS).

“Four Survey Schedules - Woman’s, Man’s, Household, and Biomarker

Results:

Fig. 1 is displaying how the practice of open defecation is distributed across India. The practice of open defecation is tremendously high in states like Jharkhand (71%), followed by Bihar (69%) and Odisha (66%). It is also high in Madhya Pradesh and Chhattisgarh (nearly 60%). The magnitude of open defecation practice is also high in Uttar Pradesh (54%) and Rajasthan (48%). Remarkably all these states belong to Empowered Action Group (EAG) states. The presence of open defecation practice is

Discussion and Conclusion:

Nutritional status is vital to track the development progress of a nation. Moreover, malnutrition is a global concern and poses many challenges in terms of health, welfare, and wellbeing. That is why it becomes an important priority in terms of the goals listed in SDGs. While Global efforts have been increased in the past few decades, countries also have framed strategies to overcome the challenges of malnutrition. On the other hand, research has thoroughly tried to sort the possible obstacles

Policy recommendations and future scope

Recently during a conference in China, the great philanthropist Bill Gates puts the human faeces on the stage for highlighting the gigantic issues of open defecation, which is also a cause of undernutrition among the children in the developing world particularly South Asia. The multiphasic reasons for undernutrition appeals for coordinated and coherent actions that go beyond the customary boundaries. Faecal pathogens’ exposure is a serious risk to children’s growth, so the improvement in the

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Not applicable.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (52)

  • S. Das et al.

    Different forms of malnutrition among under five children in Bangladesh: A cross sectional study on prevalence and determinants

    BMC Nutrition

    (2017)
  • D. Abrar

    Toilets and Sanitization for Women in India: Problems and Issues

    International Journal of Advanced Research in Management and Social Sciences

    (2015)
  • R.P. Adhikari et al.

    Determinants of stunting among children aged 0–59 months in Nepal: Findings from Nepal Demographic and health Survey, 2006, 2011, and 2016

    BMC nutrition

    (2019)
  • Augsburg, B., & Rodríguez-Lesmes, P. A. (2018). Sanitation and child health in India. World Development, 107, 22-39....
  • Brown, J., Cairncross, S., & Ensink, J. H. J. (2013). Water, sanitation, hygiene and enteric infections in children....
  • R. Chambers et al.

    Sanitation and Stunting in India: Undernutrition's Blind Spot

    Economic and Political Weekly

    (2013)
  • Chandra, R. K., & Kumari, S. (1994). Nutrition and Immunity: An Overview. The Journal of Nutrition, 124(suppl_8),...
  • D. Coffey et al.

    To end open defecation: Make Indians want to

    India Today.

    (2014)
  • D. Coffey et al.

    Understanding open defecation in rural India: Untouchability, pollution, and latrine pits

    Economic & Political Weekly

    (2017)
  • Corsi, D. J., Mejía-Guevara, I., & Subramanian, S. V. (2016). Risk factors for chronic undernutrition among children in...
  • O. Cumming et al.

    Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

    Maternal & Child Nutrition

    (2016)
  • Dangour, A. D., Watson, L., Cumming, O., Boisson, S., Che, Y., Velleman, Y., Uauy, R. (2013). Interventions to improve...
  • Desai, R., McFarlane, C., & Graham, S. (2015). The Politics of Open Defecation: Informality, Body, and Infrastructure...
  • Dodos, J., Mattern, B., Lapegue, J., Altmann, M., & Aissa, M. A. (2017). Relationship between water, sanitation,...
  • M. Ekholuenetale et al.

    Socioeconomic inequalities in hidden hunger, undernutrition, and overweight among under-five children in 35 sub-Saharan Africa countries

    Journal of the Egyptian Public Health Association

    (2020)
  • Farid, K., Zhang, Y., Bachelier, D., Gilson, P., Teixeira, A., Safar, M. E., & Blacher, J. (2013). Cognitive impairment...
  • Fernandes, E. C. B., CASTRO, T. G. D., & Sartorelli, D. S. (2017). Associated factors of malnutrition among African...
  • Galler, J. R., Bryce, C., Waber, D. P., Zichlin, M. L., Fitzmaurice, G. M., & Eaglesfield, D. (2012). Socioeconomic...
  • A. Geberetsadik et al.

    Factors associated with acute respiratory infection in children under the age of 5 years: Evidence from the 2011 Ethiopia Demographic and Health Survey

    Pediatric Health, Medicine and Therapeutics

    (2015)
  • Hammer, J., & Spears, D. (2016). Village sanitation and child health: Effects and external validity in a randomized...
  • Huda, T. M. N., Afreen, S., Arnold, B. F., Luby, S. P., Unicomb, L., Lin, A., Goto, R. (2013). Household Environmental...
  • Humphrey, J. H. (2009). Child undernutrition, tropical enteropathy, toilets, and handwashing. The Lancet, 374(9694),...
  • International Institute for Population Sciences (IIPS) & ICF. (2017). National Family Health Survey (NFHS-4), 2015-16:...
  • Khan, G. N., Turab, A., Khan, M. I., Rizvi, A., Shaheen, F., Ullah, A., Soofi, S. B. (2016). Prevalence and associated...
  • J. Khan et al.

    Spatial heterogeneity and correlates of child malnutrition in districts of India

    BMC public health

    (2018)
  • S. Khan et al.

    Determinants of stunting, underweight and wasting among children< 5 years of age: Evidence from 2012–2013 Pakistan demographic and health survey

    BMC Public Health

    (2019)
  • Cited by (22)

    • Decomposing the gap in undernutrition among under-five children between EAG and non-EAG states of India

      2023, Children and Youth Services Review
      Citation Excerpt :

      Many previous studies have examined the factors affecting U5 child undernutrition in India (Black et al., 2013; Das & Sahoo, 2011; Debnath & Bhattacharjee, 2014; Dutta, Selvamani, Singh, & Prashad, 2019; Saha & Chouhan, 2021). Undernutrition is caused by both the immediate (inadequate dietary intake, lack of care, and the onset of disease) and underlying factors (an unhealthy environment and insufficient education) (Bhutia, 2014; Cashman, Sabates, & Alcott, 2021; Jose, 2017; Pal, 1999; Rahman et al., 2020; Saha & Chouhan, 2021; Yadav et al., 2015). It has been noted that children from low-income families are malnourished not just as a result of poverty, but also as a result of limited access to maternal healthcare services and lack of newborn care due to illiteracy of parents (Kumar & Singh, 2013; Saha & Chouhan, 2021; Singh et al., 2019; Story & Carpiano, 2017; Varadharajan, Thomas, & Kurpad, 2013).

    • Thermochemically-driven treatment units for fecal matter sanitation: A review addressed to the underdeveloped world

      2022, Journal of Environmental Chemical Engineering
      Citation Excerpt :

      However, in low-income countries, the most common sanitation option for defecation is the pit latrine [12,13]; in worse scenarios, people choose to defecate in the open [14,15] to avoid using filthy pit latrines [16]. The consequence is expressed in high numbers of diseases, and mortality [17,18]. In the latrines, fresh feces are biologically transformed into a slurry mixture called fecal sludge [8], which starts to degrade and stabilize with time [19–21].

    View all citing articles on Scopus
    View full text