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Increasing latrine coverage does not by itself reduce exposure to faecal pathogens and prevent disease.

TitleEffectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India : a cluster-randomised trial
Publication TypeJournal Article
Year of Publication2014
AuthorsClasen, T, Boisson, S, Routray, P, Torondel, B, Bell, M, Cumming, O, Ensink, JHJ, Freeman, M, Jenkins, M, Odagiri, M, Ray, S, Sinha, A, Suar, M, Schmidt, W-P
Secondary TitleThe Lancet Global Health
Paginationp. e645-e653.; 4 tab.; 2 fig.;
Date Published10/2014
Publication LanguageEnglish
Keywordsdiarrhoeal diseases, helminthic infections, malnutrition, Odisha, randomised controlled trial, total sanitation campaign (TSC)

Researchers assessed the effectiveness of a rural sanitation intervention, within the context of the Government of India's Total Sanitation Campaign, to prevent diarrhoea, soil-transmitted helminth infection, and child malnutrition. They conducted a cluster-randomised controlled trial between 2010 and 2013, in 100 rural villages in Odisha, India.

The intervention increased mean village-level latrine coverage from 9% of households to 63%, compared with an increase from 8% to 12% in control villages. 7-day prevalence of reported diarrhoea in children younger than 5 years was 8·8% in the intervention group and 9.1% in the control group (period prevalence ratio 0·97, 95% CI 0·83—1·12). 

Increased latrine coverage is generally believed to be effective for reducing exposure to faecal pathogens and preventing disease; however, our results show that this outcome cannot be assumed. As efforts to improve sanitation are being undertaken worldwide, approaches should not only meet international coverage targets, but should also be implemented in a way that achieves uptake, reduces exposure, and delivers genuine health gains. [author abstract]


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